On April 1, 2025, the Federal Trade Commission (FTC) filed for a stay in a case against three Pharmacy Benefit Managers (PBMs), not because of any lack of evidence, but rather because there was no one left at the FTC to pursue the case due to recent firings by the current administration. When the suit was filed, it was supported by the three Democrat Commissioners, and the two Republican Commissioners recused themselves. A last-minute reversal of a previous recusal may have put the suit back into motion, but the entire […]

The Source team, in conjunction with The Petris Center and Catalyst for Payment Reform, has had new research published on hospital consolidation across geographic markets.  Consolidation among health systems has resulted in increased prices and caused the cost of employer-sponsored health benefits to increase much faster than inflation over the past few decades. Prior quantitative research demonstrates small, but significant price increases resulting from transactions that expand the geographic footprint of health systems, but the mechanisms by which these cross-market acquisitions raise prices is not completely resolved.  The methodology of this […]

Market Consolidation and Merger Review The Forgotten Anti-Monopoly Law: The Second Half of Clayton Act Section 7 (Texas Law Review) Robert H Lande, John M Newman, Rebecca Kelly Slaughter The authors of this article analyze the second prong of Section 7 of the Clayton Act, which prohibits mergers that “tend to create a monopoly.” In comparison to the well-known first prong that seeks to “substantially lessen competition,” the second prong is posited to wield more statutory power as it does not contain a requirement for a certain degree of harm […]

The California State Legislature kicked off the first year of its 2025-2026 biennial Legislative Session on December 2, 2024. This year, the legislature got off to a sprinting start as it raced to meet the February 21, 2025 deadline to introduce new bills. Compared to last year, this year’s legislature proposed a wider swath of bills aimed at healthcare-related concerns, including enhanced merger review, the use of artificial intelligence (AI) in healthcare, and expanding access to both provider and coverage options for consumers. In this month’s California Legislative Beat, we […]

The long-standing saga of Sidibe v. Sutter may finally be over.  The case, initially filed in federal district court for the Northern District of California in September 2012, has a long and convoluted history of complaints, amended complaints, a district court dismissal, an appeals court reversal, a summary judgment of some causes of action, a jury trial, and an appeal, among other steps. On March 2, 2025, the parties filed a notice in the U.S. District Court for the Northern District of California stating that an agreement in principle to […]

Healthcare Pricing Can Public Option Plans Improve Affordability? Insights From Colorado (Health Affairs Forefront) Roslyn Murray, Christopher M. Whaley In the face of individuals and families unable to afford increasing insurance premiums due to lack of healthcare insurance competition, a variety of states are considering offering public option plans, commonly for ACA Exchange plans. These plans seek to provide coverage with low premiums by means of capped prices for those who do not meet Medicare or Medicaid requirements nor receive private coverage through employment. The article describes Colorado’s effective public […]

On September 23, 2024, Particle Health, a startup that aggregates and shares data among healthcare providers and health technology companies, filed suit in the U.S. District Court for the Southern District of New York against Epic Systems, the nation’s largest vendor of electronic health records.  The suit alleges that Epic is using its market power to destroy competition and represents a challenge to Epic’s dominance in the patient data marketplace. Parties to the Suit Epic is a software company that provides electronic health record (EHR) resources for hospitals and health […]

On September 28, 2024, Governor Gavin Newsom vetoed Assembly Bill (AB) 3129. The landmark bill would have added restrictions around how private equity groups (PEGs) and hedge funds could participate in the ownership and management of California healthcare facilities. Introduced by Assemblymember Jim Wood and Attorney General (AG) Rob Bonta this past February, supporters of the bill had been optimistic about the bill’s potential impact on healthcare consumers and on the broader healthcare market. In this month’s California Legislative Beat, we examine how this bill could have changed healthcare transactions […]

Healthcare Competition and Consolidation Medicare Advantage and Consolidation’s New Frontier — The Danger of UnitedHealthcare for All (New England Journal of Medicine) Hayden Rooke-Ley, Soleil Shah, and Erin C. Fuse Brown This article describes the recent ransomware attack on Change Healthcare and the ownership structure of UnitedHealth Group, including how much market power it has with medical claims, data analytics, insurance, physicians, PBMs, pharmacies and a bank.  The authors note the risks involved in these types of conglomerations, including market abuses that raise costs, erode quality of care, and harm […]

In late June Novant announced it would abandon attempts to buy two Community Health Systems (CHS) hospitals in North Carolina.  This announcement followed a preliminary ruling in Federal District Court for Novant and a subsequent appellate court ruling for the Federal Trade Commission (FTC). Regardless of the final outcome of the merger, the preliminary Novant win is significant because it represents a successful use of the often cited, rarely successful, “failing firm” defense – which parties can potentially use to push through a merger that would otherwise create an unacceptable […]