Legal
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HHS Issues Proposal Bolstering Nondiscrimination Protections For People With Disabilities
HHS released a new proposed rule to update nearly 50-year old regulations protecting people with disabilities from discrimination while seeking healthcare. With its new proposal, HHS is amending the regulations to be clearer in their language, as well as more aligned with the Americans with Disabilities Act, the Americans with Disabilities Amendments Act and amendments to the Rehabilitation Act.
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HHS Will Likely Face More Lawsuits Against Drug Price Negotiation Now That It Has Named the First 10 Meds Included In the Plan
Novartis became the seventh drugmaker to legally challenge the White House’s Medicare drug pricing negotiation program. The company filed its lawsuit three days after HHS announced the first 10 drugs that were selected for the program — its heart failure medication Entresto was one on the list. HHS can expect to face more lawsuits from the manufacturers of the 10 drugs it named last week, experts have warned.
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Payer’s Place: Dr. Anil Singh
Dr. Anil Singh shares his insights into the strategies employed by the organization to identify the most effective digital solutions for their members.
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Amgen, FTC Settlement Allows $28B Horizon Acquisition to Move Forward
Amgen and the Federal Trade Commission are settling the lawsuit the regulator filed to block the pharmaceutical giant’s $28 billion Horizon Therapeutics acquisition. As part of the settlement, Amgen agrees not to “bundle” its products with Horizon’s drugs in negotiations with health plans.
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Senate Bill Proposes Slashing ‘Red Tape’ Around Biosimilar Interchangeability
Legislation introduced by Utah Senator Mike Lee would eliminate testing to show a biosimilar can be substituted for a reference biologic product. Lee contends the current testing requirement adds costs and delays market access for these lower-cost biological medicines.
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What Impact Will California’s New “Transaction Review” Law Have?
California passed a law last year aimed at controlling rising healthcare costs that gave the state the ability to scrutinize healthcare deals of a certain size involving California companies. What impact can it have?
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HHS Drops First 10 Drugs for Medicare Drug Price Negotiation
HHS released the first 10 drugs selected for the Medicare Drug Price Negotiation Program. These drugs include Eliquis, Jardiance and Xarelto. Under the program, the federal government will be able to negotiate the price for selected drugs for the first time.
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BMS Cancer Drug’s New FDA Nod Puts It on Path to Reach Blockbuster Status
Bristol Myers Squibb drug Reblozyl is now approved as a first-line therapy for anemia caused by myelodysplastic syndromes, a group of blood cancers. It’s the third indication for the drug, which analysts project could top $4 billion in peak sales.
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W-2 Employed Nurses Can Have Choice and Flexibility, Too
As the debate over worker misclassification rages, it’s important that healthcare professionals know the facts. Staffing agencies that designate their nurses as independent contractors avoid the costs of employment-related benefits like insurance, workers’ compensation, and overtime pay. These agencies also lack necessary clinical and professional oversight over their contractors, which increases the risk of substandard care.
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Bon Secours Mercy Health Sues Anthem Health Plans of Virginia for Unpaid Claims
In a new lawsuit, Bon Secours Mercy Health Virginia alleges that Anthem Health Plans of Virginia owes the health system more than $93 million in outstanding unpaid and underpaid claims.
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Discover the Next-Gen Platform for Integrated Collaborative Care
Beyond EHRs and digital front doors, reducing the gaps in patient care journeys.
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The Kids Are Not Alright: Why Pediatricians Need to Take Action to Prevent Medicaid Unwinding
Pediatricians and anyone who works with children should proactively reach out to their patients with resources and information about how to maintain coverage. Ask them to make sure their contact information is updated in state databases. Tell them to expect and respond to any communication from the state about their enrollment status.
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Floridians Sue Florida Over Medicaid Redeterminations Process
Two Florida families allege that tens of thousands of Floridians are being terminated from Medicaid coverage without sufficient information as to why. This comes as the U.S. continues the unwinding of the Medicaid continuous enrollment requirement, which stopped states from disenrolling Medicaid enrollees during the Covid-19 public health emergency.
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Teva, Glenmark To Pay $255M, Divest Cholesterol Drug to Settle DOJ Price Fixing Charges
Generic drugmakers Teva and Glenmark recently became the sixth and seventh drugmakers to resolve criminal charges as a result of the DOJ’s yearslong investigation into generic drug price fixing. The settlement agreement requires both companies to pay hefty fines as well as divest their drug lines for pravastatin, a widely used statin that lowers cholesterol.
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Congressman Launches Investigation into Medicaid Prior Authorization Denials
U.S. Representative Frank Pallone, Jr. (D-New Jersey) announced that he is looking into high prior authorization denial rates by Medicaid managed care health plans. It follows a report by the Office of Inspector General that found that Medicaid MCOs denied one out of every eight prior authorization requests in 2019.
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Hospitals, Legal, Social Determinants
43K Patients in California Could Get Refunds, Bill Corrections As Part of Discounted Care Settlement
Santa Clara Valley Healthcare in California has begun notifying 43,000 patients about their eligibility for billing corrections and refunds. The system’s patient outreach effort is a result of a recently settled lawsuit filed against Santa Clara County. In the complaint, former patients alleged the county did not inform them about its hospitals’ charity care and discount payment policies, leading them to have to pay large bills.
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Pfizer Expands to Multiple Myeloma With FDA Approval for New Antibody Drug
Oncology is already a big piece of Pfizer’s drug lineup. The portfolio is expanding to multiple myeloma with FDA approval of Elrexfio, a bispecific antibody that targets the cancer protein BCMA.
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Payer’s Place: Dawn Maroney
Dawn Maroney, President, Markets of Alignment Health and CEO of Alignment Health Plan, to discuss how they are using technology to provide better service and care to consumers.
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Applying Remote Patient Monitoring to Surgery Prep and Recovery, Oncology and Women’s Health
Join us to learn about the latest trends in remote monitoring and how to extend its benefits beyond chronic conditions to more patients – all while using fewer staff resources.
