Source Shorts
Updated – Source Short: Congress Acts to Ban Gag-clauses in Pharmacy Contracts
Katie Gudiksen, Senior Health Policy Researcher September 27, 2018
*Updated: September 27, 2018 On Tuesday, September 25, the House voted to pass the Patient Right to Know Drug Prices Act, so the bill currently awaits President Trump’s Signature. In addition, both the House and Senate passed the Know the Lowest Price Act of 2018 (S.2553), which bans gag-clauses in Medicare Advantage or Medicare Part D plans. In a tweet on September 17, President Trump expressed his support of legislation that will remove gag clauses. As a result, gag-clauses at pharmacy counters will likely be prohibited, so pharmacists will be …
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Source Short: Senate Passes Legislation Banning Gag-clauses in Pharmacy Contracts
Katie Gudiksen, Senior Health Policy Researcher September 19, 2018
On Monday, September 17, the Senate overwhelmingly passed S.2554, the Patient Right to Know Drug Prices Act, with a vote of 98-2.[1] Congress appears to be building on the momentum of recent state action to prohibit gag-clauses that prevent pharmacists from telling insured patients when the cost of their co-payment exceeds the cash price of the drug. While the Senate bill does not forbid pharmacists from collecting more than the cash price for a prescription, it does allow them to tell patients when their out-of-pocket costs using their health plan …
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Update on Massachusetts’ Waiver Request to use a Drug Formulary for Medicaid
Katie Gudiksen, Senior Health Policy Researcher July 9, 2018
On June 27, 2018, the Centers for Medicaid and Medicare Services (CMS) denied Massachusetts’ request to implement a closed drug formulary in its Medicaid program. In a previous post, the Source described the request and explained why it has the potential to save the state millions of dollars every year. In denying the request, CMS said that it would consider the waiver if Massachusetts no longer used the federal Medicaid Drug Rebate Program in which manufacturers give the state rebates when the state purchases a drug to ensure that Medicaid …
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California Attorney General Sues Sutter Health for Anticompetitive Practices
Amy Y. Gu, Managing Editor March 30, 2018
See UFCW & Employers Benefit Trust v. Sutter Health case page. California’s attorney general announced today that his office has filed an antitrust and unfair competition lawsuit against Sutter Health. Attorney General Xavier Becerra said at a press conference that the state’s complaint follows a six-year statewide investigation that found the Northern California hospital giant engaged in anticompetitive conduct that drove up healthcare prices for patients and employers in the state. Specifically, the complaint alleges that Sutter engaged in “all-or-nothing” contracts with health insurers that restricted insurers from providing low-cost plan options …
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Source Shorts: White House Releases Report on Drug Pricing
Katie Gudiksen, Senior Health Policy Researcher February 13, 2018
On Friday, February 9, 2018, the White House released a report from the Council of Economic Advisers (CEA) entitled “Reforming Biopharmaceutical Pricing at Home and Abroad”. The report identifies two seemingly conflicting goals of the current administration: 1) reducing domestic drug prices and 2) spurring economic investment in medical innovation. These goals appear to conflict since lower prices would likely mean lower profits for drug companies, resulting in lower investment in research and development. The report also accuses foreign governments of eroding global returns for investment in pharmaceuticals, stating: “nations …
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Source Short: A Basic Understanding of What’s Really Driving Healthcare Costs
Amy Y. Gu, Managing Editor October 12, 2017
It’s common knowledge that the U.S. spends more than any other country on health care. In a series of blog posts, David Lansky, PhD of the Center for Health Journalism aims to give us a basic summary and understanding of the many factors contributing to the out of control healthcare spending. In part 1 of his blog post, Lansky explains why our healthcare spending is so high, and the five main culprits that push costs up. In part 2 of his blog post, Lansky outlines additional factors that should bring …
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Source Shorts: Medicare Officially Kills Program to Pilot Pharmaceutical Payment Reform
Katie Gudiksen, Senior Health Policy Researcher October 4, 2017
The Centers for Medicaid and Medicare officially dropped any attempt to implement a pilot program that would change the way drugs were reimbursed under Medicare Part B. This pilot reform attempt has been on hold for more than a year, but CMS has now officially withdrawn it. How does Medicare Part B cover prescriptions? Medicare Part B only covers drugs that are administered in a doctor’s office or clinic, which are primarily intravenous and injectable drugs (the bulk of pharmaceuticals are covered under Medicare Part D and would not …
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Pfizer files Groundbreaking Lawsuit against J&J Alleging Anticompetitive Practices
Katie Gudiksen, Senior Health Policy Researcher September 28, 2017
Pfizer filed a lawsuit on Wednesday, September 20, alleging Johnson &|Johnson (J&J) made “exclusionary contracts” with insurers regarding their drug Remicade. Remicade (infliximab) is biologic medication that must be administered via IV infusion. In contrast to most drugs that are chemically synthesized, biologic medications are large biological molecules or complex mixtures that are not easily duplicated. Remicade (infliximab) is a monoclonal antibody. As biologic medications cannot be exactly duplicated, the FDA process for approving biosimilars is similar but not identical to the Abbreviated New Drug Application (ANDA) process for small molecule generic drugs. …
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Washington State AG files suit against Franciscan Health System
Katie Gudiksen, Senior Health Policy Researcher September 12, 2017
The Washington State AG filed suit to thwart and unwind Franciscan Health Systems (FHS) most recent expansion attempts alleging violation of both state and federal antitrust laws. In a rarely seen antitrust enforcement action, the Washington AG’s office is asking the court to unwind FHS’ 2016 acquisition of WestSound Orthopaedics for violation of Section 7 of the Clayton Act and the Washington Consumer Protection Act and several affiliation agreements from 2016 between The Doctors Clinic and FHS for violation of Section 1 of the Sherman Act and the Washington Consumer …
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Class Certification Granted in UFCW & Employers Benefit Trust v. Sutter Health
Anna Zaret, Managing Editor August 22, 2017
See UFCW & Employers Benefit Trust v. Sutter Health case page. We have previously blogged about a key California case brought by self-funded payers against Sutter Health, the dominant health care provider in Northern California, UFCW &|Employers Benefit Trust v. Sutter Health. Last week, the plaintiffs overcame a major hurdle in litigation when the court granted class certification. To remind you, UEBT filed this class action on behalf of itself and other self-funded payers. The defendants in the case are Sutter and the group referred to as “Network Vendors,” which are the …
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