Overview
Alabama is one of the few states that prohibits most non-compete provisions in employment contracts for professionals, which include physicians. Specifically, the courts held that statutory exemptions allowing non-competes in employment contracts do not apply to professionals and that physicians and other medical providers are professionals under state law.
While the state does not have statutory authority for review or approval of provider mergers, Alabama is the site of a major private antitrust enforcement action against health insurer Blue Shield/Blue Cross. Healthcare providers and individual and small-employer customers separately sued BCBS of Alabama in 2013, alleging horizontal market allocation and conspiracy to divvy up insurance markets all over the country in violation of Section 1 of the Sherman Antitrust Act. The lawsuits were consolidated as MDL in the Northern District of Alabama, which held that the alleged practice of creating exclusive territories is a “per se” violation of the Sherman Antitrust Act and would be subject to the highest legal standard. After the 11th Circuit upheld the decision, BCBS agreed to a settlement agreement with employer subscribers that would pay $2.7 billion to the class plaintiffs, in addition to modification of alleged anticompetitive practices.
See below for an overview of existing Alabama state mandates.
State Action
Latest Legislative Session: 3/7/2023 - 6/6/2023 (2023 term). *Current session bill updates are ongoing. Check back weekly for updates.
HB 475 – Alabama
Introduced: 2023 Status: Inactive / Dead
Relating to rural hospitals; to provide for funding of rural hospitals by creating the Rural Hospital Investment Program; to establish a governing board to administer the program, to provide for a state income tax credit …
HB 48 – Alabama
Introduced: 2018 Status: Enacted
Enacted as Ala. Code Ann. § 11-91A-2 LOCAL GOVERNMENT HEALTH INSURANCE PROGRAM: provides that any entities or organizations added to the Local Government Health Insurance Program, which were not identified as employer participants eligible for participation …
HB 492 (see companion bill SB 227) – Alabama
Introduced: 2021 Status: Inactive / Dead
Pharmacy benefits managers, practices relating to patient steering, price discrimination, fiduciary duty to client, price disclosure, etc. regulated, Dept of Insurance, duties and authorities revised, Act 2019-457, 2019 Reg. Sess., sections amended and renumbered; Secs. …
HB 50 (see companion bill SB 25) – Alabama
Introduced: 2019 Status: Inactive / Dead
Physical therapy, eliminate requirement for referral from physician or other health care practitioner to perform physical therapy, Secs. 34-24-191, 34-24-210.1, 34-24-217 am’d.
HB 518 – Alabama
Introduced: 2023 Status: Inactive / Dead
Regarding health insurance; to provide for a state health care exchange pursuant to the federal Affordable Care Act; to establish a governing board of directors and an executive director and require the board to operate …
Ala. Code § 22-21-318. Powers of Authority: Health Care Authorities – Alabama
Introduced: Status: Enacted
Statute gives various powers to public corporations that operate health care facilities. Statute also provides immunity from state or federal antitrust laws.
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Ala. Code § 22-21-336. Transfer of funds and assets to authority: Health Care Authorities – Alabama
Introduced: Status: Enacted
Statute authorizes any municipality, county, or educational institution, any public hospital corporation and any other public agency, authority or body to transfer of funds and assets to any authority. When doing so, entity does not …
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Ala. Code § 22-21-7. Itemized statement of services rendered to be furnished patient upon request; provisions of statement; itemization of services and expenses; action by Attorney General; payment of claims by insurance companies: Hospitals and Other Health Care Facilities Generally – Alabama
Introduced: Status: Enacted
Within 10 days following discharge, a hospital or nursing home providing services to a patient shall submit to the patient an itemized statement detailing in language comprehensible to an ordinary layman the specific nature of …
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Ala. Code § 22-6-122. Medicaid Pharmacy and Therapeutics Committee — Classification and recommendation of drugs; assurance of quality patient care; review of pharmaceutical products: Medicaid Preferred Drug Plan – Alabama
Introduced: Status: Enacted
Medicaid shall make available the preferred drug list to Alabama Medicaid providers
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Ala. Code § 22-6-123. Considerations for inclusion on preferred drug list; review; adoption of list: Medicaid Preferred Drug Plan – Alabama
Introduced: Status: Enacted
Until Medicaid adopts the preferred drug list, Medicaid shall continue to use its existing voluntary preferred drug list and prior authorization program
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In the Matter of Community Health Systems, Inc. and Health Management Associates, Inc. – Alabama, South Carolina
District Court: United States of America Before The Federal Trade Commission Status: Decided
In April 2014, the Federal Trade Commission issued its final order in connection with Community Health Systems, Inc.’s proposed $7.6 billion acquisition of rival health system Health …
In Re Blue Cross Blue Shield Antitrust Litigation – Alabama
District Court: N.D. Alabama Status: Decided
On April 5, 2018, U.S. District Court Judge R. David Proctor of the Northern District of Alabama held in a decision that the Blue Shield/Blue …
In re: Suboxone Antitrust Litigation (State of Wisconsin, et al. v. Indivior Inc, et al.) – Alabama, Alaska, Arkansas, California, Colorado, Connecticut, Delaware, District of Columbia, Florida, Georgia, Hawaii, Idaho, Illinois, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Nebraska, New Hampshire, New Mexico, New York, North Carolina, Ohio, Oklahoma, Oregon, Pennsylvania, South Dakota, Tennessee, Utah, Virginia, Washington, West Virginia, Wisconsin
District Court: E.D. Pennsylvania Status: Pending
In September 2016, 35 state attorneys general and the District of Columbia brought a multi-district case against pharmaceutical manufacturer Indivior, MonoSol RX et al., alleging …
In Re: Generic Pharmaceuticals Pricing Antitrust Litigation – Alabama, Alaska, Arizona, Arkansas, California, Colorado, Connecticut, Delaware, District of Columbia, Florida, Hawaii, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, South Carolina, Tennessee, Utah, Vermont, Virginia, Washington, West Virginia, Wisconsin
District Court: Eastern District of Pennsylvania Status: Pending
Plaintiffs are attorney generals from 48 states, Puerto Rico, and the District of Columbia, as well as classes of private plaintiffs that filed an antitrust …
Additional Resources
STATE BUDGET
Alabama’s fiscal year runs from October 1 and ends on September 30 of the following year. To view Alabama’s most recent Budget proposal, click here.
REGULATION & ENFORCEMENT
- FTC Review of Community Health Systems / Health Management Associates Merger: In April 2014, the Federal Trade Commission issued its final order in connection with Community Health Systems, Inc.’s proposed $7.6 billion acquisition of rival health system Health Management Associates, Inc. The FTC required Community Health Systems, one of the nation’s largest hospital operators, to divest hospitals and related assets, including outpatient facilities, in Alabama and South Carolina as a condition of the acquisition. Prior to issuing the order, in March 2015, the FTC approved CHS’s sale of a Gadsen hospital in accordance with its order. Find the FTC case summary and related documents here.
KEY RESOURCES