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 […]

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 […]

Department of Justice Looking Into United Health On February 21, 2025, the Wall Street Journal reported that the Department of Justice (DOJ) has launched a civil fraud investigation against UnitedHealth.  The investigation is centered on Medicare billing practices, with sources saying that UnitedHealth-employed physicians were trained to document higher revenue-generating diagnoses, even if that was not what patients were being treated for.  Additionally, the investigation is apparently looking into claims that UnitedHealth used software to suggest additional codes and offered bonuses to clinicians who coded for these additional diagnoses.  If […]

On January 10, 2025, Governor Newsom released his proposed California state budget for the 2025-26 term. Following last year’s $46 billion budget shortfall, the Governor’s new budget looked quite different this year. Specifically, the budget had no deficits, reporting a projected surplus of $363 million due to the state’s prediction that it will collect almost $17 billion more in revenue than was originally planned. In fact, this year is slated to go down as California’s second-largest state spending plan ever, at a value of almost $322 billion. Overview of the […]

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 […]

In November of 2024, three lawsuits were filed by pharmaceutical manufacturers against the Department of Health and Human Services (HHS) and the Health Resources and Services Administration (HRSA), challenging how HRSA oversees the Federal 340B Drug Pricing Program.  (HRSA is the sub-agency within HHS that administers the 340B Program). The potential impact of the lawsuits on the 340B Program is significant in its own right, but the outcome of the lawsuits could also have an indirect effect on merger and acquisition activity.  Research has indicated that the merger and acquisition […]

The California legislation concluded the 2024 legislative session when it adjourned on August 21, 2024. Overall, the legislature introduced a variety of health care bills spanning a list of hot-topic issues from Medi-Cal eligibility to health care worker minimum wage increases. Below we recap noteworthy bills from the 2024 legislative session impacting California’s health care market that were not enacted (to learn what bills were enacted please see Recapping the 2024 California Legislative Session: Artificial Intelligence, Debt, and More). The bills covered are arranged by issue relating to Pharmaceuticals, Health […]

Price Transparency Hospital Payment Caps Could Save State Employee Health Plans Millions While Keeping Hospital Operating Margins Healthy (Health Affairs) Roslyn C. Murray, Christopher M. Whaley, Erin C. Fuse Brown, Andrew M. Ryan As health insurance premiums continue to rise, state employee health plans are occupying an increasing portion of state budgets. State employers are often the largest purchaser or commercial health insurance in each state, given the volume of employees that they employ. As such, state governments are placed in a unique negotiating position to implement cost containment strategies. […]

Healthcare Competition and Consolidation Are “All or Nothing” Contracts by Hospital Systems Anti-Competitive? – Evidence from a Recent Antitrust Lawsuit (Journal of Hospital Management and Health Policy) Glenn Melnick, Katya Fonkych Research has consistently shown that hospital prices are a major driver of increasing healthcare costs in the United States, with the expansion of multi-hospital systems contributing highly to this trend. While contracts between hospitals and health plans have been suspected to contribute to increasing prices, these assertions could not be confirmed until recently since many of these contracts have […]