THE SOURCE BLOG

As states step up their efforts to control prescription drug prices, many state legislatures have targeted pharmacy benefit managers (PBMs) and their role in rising prices by introducing legislation to bring greater transparency to the inner workings of PBMs. As a result of these efforts, however, states increasingly face challenges from the pharmaceutical industry, specifically the Pharmaceutical Care Management Association (PCMA), a trade association representing PBMs. Over the years, PCMA has brought a number of lawsuits challenging state legislation regulating PBMs, claiming that the Employee Retirement Income Security Act (ERISA) …

Happy November!  If you’re wondering what to do with that extra hour as Daylight Savings ends, why not peruse the latest in healthcare news?  In this month’s Source Roundup, we look at articles that analyze 1) the role of waste and prescription drug prices in increasing healthcare costs, 2) the impact of market concentration and competition in healthcare pricing, and 3) the projected impact of healthcare reform proposals.   Healthcare Spending Increases Due to Waste and Rising Prescription Drug Costs As Americans dig deeper into their pockets to pay for …

To lower health care costs, transparency is critical. The recently approved SB 343 is California’s next step toward greater price transparency. This bill would require Kaiser Permanente to report the same amount and type of information as any other hospital and health plan would. This change underscores a new reality: while Kaiser may be structurally different from its competitors, its premiums are similarly priced. Because Kaiser covers nearly two thirds of the large group market enrollees (i.e. employers with more than fifty employees), SB 343 fills an important data gap …

As the healthcare industry grapples with the recent settlement of the antitrust case against Sutter Health, The Source Executive Editor Jaime King discusses the possible motivations and implications of this development in Tradeoffs, a healthcare podcast. In Episode 2 of the podcast, The Train Has Left the Station, Professor King points out that because Sutter is a model for many other health systems around the country, the lawsuit against Sutter’s contracting practices, including all or nothing provisions, had the potential to send shockwaves through the system. The actual implications of …

The historic court case against Sutter Health alleging anticompetitive contract practices took an unexpected turn today when Judge Anne-Christine Massullo of the Superior Court of San Francisco dismissed the jury, announcing that Sutter has reached a preliminary settlement with the California AG and class action plaintiffs. Opening arguments in the case were set for October 21, after it was delayed from October 10 due to an insufficient number of jurors. The trial was estimated to last about 12 weeks and would have put the spotlight on the details of Sutter …

Updated 10/11/19: Start of Trial further delayed to Monday, October 21 per 10/11 hearing regarding jury selection. By: Alex Montague, Graduate Research Fellow Opening arguments for the antitrust case against Sutter Health, set to begin Oct 10 at 10:15am in the Superior Court of San Francisco, were postponed today after the court expressed concern that there was an insufficient number of jurors available to move forward for the trial. Several jurors were absent for today’s trial due to medical conditions and various other reasons, with several more expressing that they …

The landmark antitrust case against Sutter Health, the largest provider of general acute hospital services in Northern California, is set to begin jury trial in the Superior Court of San Francisco on October 10 and is expected to last 12 weeks. The trial will begin at 10:15am with opening arguments from both parties. The Source has been closely tracking this case leading up to the trial. Executive Editor Jaime King was quoted in multiple news outlets, including the New York Times, San Francisco Chronicle, and Bloomberg Law, regarding the ripple …

As part of the Case Watch series for the landmark antitrust suit against Sutter Health, this post takes a look back at the Superior Court of San Francisco’s orders from March and June 2019, denying Sutter’s motions for summary judgment, which set the stage for the jury trial, set to begin on Thursday, October 10, 2019. As a preview of the legal arguments we will see at trial, we dissect each of the four causes of action brought against Sutter in the context of Sutter’s motions and the court’s rulings. …

The autumnal season is upon us!  This month, we pull no tricks, and treat you to a review of articles and reports about 1) the impact of healthcare market concentration, 2) the potential use for price transparency, and 3) government efforts to influence pharmaceutical pricing.   Conflicting Views on How Market Concentration Impacts Healthcare Prices Two recent reports point to an increase in healthcare market concentration and discuss the effects on price and competition.  The American Medical Association (AMA) just published the 2019 edition of the annual study of market …

Updated 10/14/2019: Governor Newsom has signed AB 651, which will take effect January 1, 2020.   There are few bills in the 2019 California Legislative cycle more supported by the Legislature than AB 651, which would reauthorize the Emergency Medical Air Transportation Act (“Act”) and prohibit balance billing by air ambulances. To fully understand the impact and significance of AB 651, we will first examine the history and evolution of the Emergency Medical Air Transportation Act, starting in 2010, to better appreciate the original intent of the Act. Second, we …