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16 04, 2024

Recent lawsuits focus on key competition issues

This spring, court cases are dealing with a variety of issues relevant to healthcare marketplace competition issues.  These include a Federal Trade Commission’s (FTC’s) action to block a sale of hospitals in North Carolina, examining the fiduciary duties employer-sponsored health plans have in selecting drug plans, and looking at the acceptability of non-compete clauses in physician contracts. FTC Files suit in North Carolina In February, the FTC authorization of a suit to block Novant Health’s proposed acquisition of two hospitals owned by Community Health Systems (CHS) in North Carolina.  On March 25, the FTC [...]

Recent lawsuits focus on key competition issues
27 03, 2024

SB 228

Health Insurance Cost Sharing: Defining the term “cost-sharing requirement”; requiring specified individual health insurers and their pharmacy benefit managers to apply payments by or on behalf of insureds toward the total contributions of the insureds’ cost-sharing requirements; providing disclosure requirements for specified health insurers and their pharmacy benefit managers; requiring that specified contracts require pharmacy benefit managers to apply payments by or on behalf of insureds toward the insureds’ total contributions to cost-sharing

SB 228
27 03, 2024

HB 363

Health Insurance Cost Sharing: Requires specified individual health insurers, group insurers, HMOs & their pharmacy benefit managers to apply payments of prescription drugs by or on behalf of insureds & subscribers toward total contributions of insureds' & subscribers’ cost-sharing requirements under certain circumstances; provides disclosure requirements; requires specified contracts to require PBMs to apply payments by or on behalf of insureds & subscribers toward insureds' & subscribers’ total contributions to cost-sharing requirements.

HB 363
27 03, 2024

SB 1502

Establishing a 3-year statute of limitations for an action to collect medical debt for services rendered by a health care provider or facility; providing additional personal property exemptions from legal process for medical debts resulting from services provided in certain licensed facilities; requiring a licensed facility to post on its website a consumer-friendly list of standard charges for a minimum number of shoppable health care services; prohibiting certain collection activities by a licensed facility, etc.

SB 1502
27 03, 2024

SB 1608

Prohibiting certain actions by health insurance issuers, pharmacy benefit managers, or other third-party payors, or their agents, relating to reimbursement to a 340B entity for 340B drugs; prohibiting certain actions by manufacturers relating to interference with the acquisition of a 340B drug; prohibiting a manufacturer’s interference with a pharmacy’s right to contract with a 340B entity, etc.

SB 1608
29 01, 2024

HB 11

A bill specifying that certain restrictive covenants in employment agreements relating to certain licensed physicians are not supported by a legitimate business interest; specifying that such restrictive covenants are void and unenforceable; providing applicability; defining the term "compensation"; providing an effective date.

HB 11
29 01, 2024

HB 1475

Provides requirements related to utilization review entities authorization process for accepting electronic prior authorization; provides requirements related to payment adjudicators; authorizes OIR to investigate & take appropriate actions; authorizes provider to bring private cause of action; revises requirements of insurer contracts; revises requirements for health insurers submitting claims electronically & nonelectronically; removes prohibition against waiving, voiding, or nullifying certain provisions by contract; prohibits health insurer from retrospectively denying claim; revises procedures for investigation of claims of improper billing; prohibits insurer from requiring information from provider before provision of emergency services & care.

HB 1475
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