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Federal authorities move to close mammoth drug-pricing loophole
Years after the potential for abuse was flagged in Ohio, the federal agency that oversees Medicaid is moving to close a loophole that likely is worth billions to prescription drug middlemen. The Centers for Medicare and Medicaid Services have proposed a new rule that it said would help ensure compliance with a requirement under federal […]
Health care giant pays Iowa $44M to settle fraud claims
The nation’s largest Medicaid managed-care company has agreed to pay Iowa $44.4 million to settle claims that it defrauded the state’s Medicaid system. That makes it the latest state to settle claims that were originally raised in Ohio in 2021. St. Louis-based Centene agreed to pay the money over claims that its subsidiary, Iowa Total […]
Deep inside the gun bill: a break for prescription drug middlemen
Many Americans across the political spectrum are clamoring for federal action on guns in the wake of a mass shooting at an Uvalde, Texas, elementary school, a Buffalo, N.Y., grocery store and hundreds of other places. But buried in a bipartisan compromise hashed out by the U.S. Senate on Tuesday is an unrelated provision they […]
Feds to probe drug rebates
The Federal Trade Commission has announced what some observers believe could be a game-changer when it comes to the rising cost of prescription drugs. The agency — which is meant to protect fair competition — said last week it would look into the murky practice by which drugmakers grant rebates and other fees to insurer-owned […]
CVS sometimes forces people to use its pharmacies. Now the Supreme Court will weigh in
CVS Health and other massive corporations often use their pharmacy middleman subsidiaries to force people to get the most expensive class of drugs from the businesses’ own mail-order pharmacies. Some call the practice “patient steering.” CVS and companies such as UnitedHealth and ExpressScripts/Cigna say the arrangements save patients money. But some patients, oncologists and other […]
Biden administration announces ‘comprehensive’ plan to fix high drug prices
The U.S. Department of Health and Human Services has issued its plan to address high drug prices as part of President Joe Biden’s push to take on anticompetitive practices across the economy. But while it addressed in detail abusive practices by drugmakers, it was a lot more superficial about the practices of much-larger corporations that […]
In court, drug middlemen fight to limit pharmacies insured patients can use
In the first test of a 2020 U.S. Supreme Court ruling, drug middlemen last week argued that federal law gives them a crucial right to limit which pharmacies patients with health insurance can use — or at least make it more expensive if patients get their medicine at a shop that isn’t preferred by the […]
Centene agrees to settle Medicaid claims with Ohio, Mississippi for $143 million
In what could be a harbinger of more settlements, Medicaid managed-care contractor Centene on Monday settled potential fraud claims by Ohio and Mississippi for $88.3 million and $55 million, respectively. Ohio is the only state to file suit so far alleging improper double billing through Centene’s pharmacy middlemen. But Mississippi, Kansas, Arkansas, Georgia, Oklahoma and […]
Grassley urges federal probe of drug middlemen
After years of accusations around the country, a bipartisan group in the U.S. Senate wants federal regulators to investigate whether drug middlemen and their parent companies are rigging the system to raise prices and pad their pockets. Sens. Chuck Grassley, R-Iowa, and Maria Cantwell, D-Wash., last month filed legislation that would require the federal trade […]
Supreme Court hears arguments over states’ ability to regulate drug costs
How much leeway states have to control drug middlemen was at the heart of arguments this week before the U.S. Supreme Court. The case, Rutledge v Pharmaceutical Care Management Association, pits 47 state attorneys general — including Iowa’s — and the U.S. Solicitor General against an industry group representing three of the 20 largest corporations […]
As federal jobless benefits expire, overwhelmed state systems often can’t fill the void
Congress is continuing to squabble over whether to extend a federal supplement to unemployment insurance and if they do, by how much. But as politicians argue over whether to continue the supplement at $600 a week or some fraction of that, out-of-work Americans are left to worry whether they can survive on state benefits that […]