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14 06, 2022

Q2 2022: Antitrust Enforcement Actions Flourish Against Healthcare Consolidation and Anticompetitive Contracting

It's been a busy month in healthcare antitrust land, both for federal regulators and private plaintiffs, as we saw an explosion of enforcement actions challenging both proposed mergers and anticompetitive conduct that stemmed from previous mergers. From New Jersey to Utah, large health systems such as HCA are being increasingly scrutinized and coming under fire for garnering and using their market power in anticompetitive ways.   Merger Challenges Fresh from its appeals court win in the Hackensack Meridian and Englewood merger challenge, the Federal Trade Commission (FTC) is continuing its momentum and kicking off [...]

Q2 2022: Antitrust Enforcement Actions Flourish Against Healthcare Consolidation and Anticompetitive Contracting
13 06, 2022

Uriel Pharmacy v. Advocate Aurora Health

Brought by Uriel Pharmacy, a self-insured employer, the federal lawsuit alleges Advocate forced insurers to enter all-or-nothing and anti-tiering and anti-steering contract terms. In addition, the plaintiffs claim Advocate Aurora uses "a combination of acquisitions, referral restraints, noncompetes and gag clauses to suppress competition from other healthcare providers" and expand its monopoly power. With its must-have hospitals, the health system was able to demand higher prices for its services compared to other providers. The complaint cites the example of the price of joint replacement surgery, which costs $62,538 at Advocate Aurora hospitals, $21,000 higher [...]

Uriel Pharmacy v. Advocate Aurora Health
22 03, 2022

SB 539 (see companion bill AB 548)

This bill requires the commissioner of insurance, in consultation with persons interested in the sale and pricing of prescription drugs and federal officials and agencies, to design and implement a prescription drug importation program for the benefit of and that generates savings for Wisconsin residents.

SB 539 (see companion bill AB 548)
22 03, 2022

AB 559 (see companion bill SB 552)

An Act relating to: eliminating cost sharing for prescription drugs under the Medical Assistance program. Under current law, certain persons who receive health services under the Medical Assistance program, also known in this state as BadgerCare, are required to contribute a cost sharing payment to the cost of certain health services. This bill eliminates all cost sharing payments for prescription drugs under the Medical Assistance program.

AB 559 (see companion bill SB 552)
22 03, 2022

SB 552 (see companion bill AB 559)

An Act relating to: eliminating cost sharing for prescription drugs under the Medical Assistance program. Under current law, certain persons who receive health services under the Medical Assistance program, also known in this state as BadgerCare, are required to contribute a cost sharing payment to the cost of certain health services. This bill eliminates all cost sharing payments for prescription drugs under the Medical Assistance program.

SB 552 (see companion bill AB 559)
22 03, 2022

SB 549 (see companion bill AB 553)

An Act relating to: fiduciary and disclosure requirements on pharmacy benefit managers. The bill provides that a pharmacy benefit manager owes a fiduciary duty to a plan sponsor. The bill also requires that a pharmacy benefit manager annually disclose all of the following information to the plan sponsor: 1. The indirect profit received by the pharmacy benefit manager from owning a pharmacy or service provider. 2. Any payments made to a consultant or broker who works on behalf of the plan sponsor. 3. From the amounts received from drug manufacturers, the amounts retained by [...]

SB 549 (see companion bill AB 553)