Morning Briefing
Summaries of health policy coverage from major news organizations
UnitedHealthcare, OptumRx Sued Over Alleged 'Spread Pricing' For Drugs
Modern Healthcare: Louisiana Sues UnitedHealthcare, OptumRx For Alleged Medicaid Drug Overcharging
Louisiana's attorney general sued UnitedHealth Group's OptumRx and UnitedHealthcare businesses, alleging the pharmacy benefit manager and insurer overcharged the state's Medicaid department by billions of dollars through inflated prescription drug prices. In a suit filed in the Nineteenth Judicial District Court in East Baton Rouge Parish on April 13, Attorney General Jeff Landry alleged UnitedHealth Group was paid more money from the state because its Medicaid managed-care and PBM business arms gave it a "perverse incentive structure" to balance its medical loss ratio. State and federal government laws require that insurers spend a certain portion of every premium dollar on patient care through MLRs. (Tepper, 4/20)
Stat: Louisiana Accuses UnitedHealth And Its OptumRx PBM Of Inflating Drug Costs For Its Medicaid Program
Notably, the lawsuit contended the companies engaged in spread pricing, which refers to the difference between the dispensing fees that pharmacy benefits managers pay pharmacies and the higher rates they bill to state Medicaid programs. Although spread pricing is very much a behind-the-scenes issue, it has gained increasing attention. Dozens of states have proposed or passed 160 laws to tighten oversight of PBMs over the past few years, according to the National Academy for State Health Policy, a group of state policy experts that has been active in proposing legislation to control prescription drug spending. (Silverman, 4/20)
In other news about health care costs and medical bills —
CBS News: Americans Often "Forced" To Pay Medical Bills They Don't Owe, Feds Say
It may come as little surprise that many Americans are besieged by medical bills, especially as the COVID-19 pandemic grinds on. Perhaps more eye-opening is that this is often for debt they have already paid or do not actually owe. In a new report, the Consumer Financial Protection Bureau found that people's most common debt collection complaints last year had to do with efforts to collect on a bill that they said did not belong to them. (Sherter, 4/20)
Houston Chronicle: Houston Doctors Weigh In On How Mounting Medical Debt, Bills Affect Patient Health
Medical debt and financial burdens of paying for health care can drastically increase stress, reduce quality of life and, in some cases, lead to earlier deaths for insured and uninsured alike, experts said at a presentation at Rice University’s Baker Institute for Public Policy on Wednesday. Dr. Khurram Nasir, a cardiologist at Houston Methodist, shared a story about a friend, a small business owner, who was uninsured and suffered from a heart attack. To his and his family’s relief, he survived. But that relief didn’t last long. (Carballo, 4/21)
Modern Healthcare: Surprise Bill Resolutions' Path Forward Hinges On Final Rule
The portal to file surprise billing independent dispute resolution claims opened on Friday, but there's a chance the process through which claims are resolved could shift in the coming months. The Centers for Medicare and Medicaid Services released revised guidance on the resolution process last week after a Texas federal judge ruled in February that previous policy couldn't stand, in part because it unfairly advantaged insurers. But between other litigation and a final rule coming this summer, CMS still has opportunities to tweak the process. (Goldman, 4/20)
KHN: Is My Drug Copay Coupon A Form Of Charity — Or A Bribe?
Before my insurer had even preapproved coverage of the new injectable medicine my doctor had prescribed, I got a voicemail from its manufacturer informing me that I might qualify for its copay assistance program. That meant the company would cover at least the lion’s share of my copay, leaving me with a minimal, if any, out-of-pocket contribution. My antennae were up: If a drugmaker is offering copay assistance, you can assume the list price of the drug is high, but I wasn’t sure how high. Did this outwardly kind offer represent, essentially, a kind of bribe? (Rosenthal, 4/21)
