News for Insurers
Top stories summarized by our editors
9/18/2018

The Justice Department has given antitrust approval to Cigna's acquisition of pharmacy benefit manager Express Scripts, clearing the way for the companies to close the deal by the end of this year. The DOJ determined that the transaction is "unlikely to result in harm to competition or consumers."

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MedCity News, CNBC
9/18/2018

A known animal and suspected human carcinogen, N-Nitrosodiethylamine, has been found in some of Torrent Pharmaceuticals' recently recalled valsartan products, which are indicated for patients with heart failure and hypertension. The additional impurity was found in valsartan products with lot numbers BV47D001, BV48D001 and BV48D002.

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eMPR
9/18/2018

Pharmacy benefit managers negotiate drug rebates that allow health plans to reduce their operating costs and keep the cost of insurance low, writes Tony Lo Sasso, a professor of health policy and administration at University of Illinois at Chicago. "To assume that this particular method of reducing costs accrues solely to the provider in the form of excess profits is nonsensical; insurance companies do face competition: none has a guaranteed client for the indefinite future that does not care about cost," Lo Sasso writes.

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The Weekly Standard
9/18/2018

The Pharmaceutical Care Management Association "strongly supports S. 2554, legislation that will ensure America's patients always pay the lowest cost for their medications at the pharmacy counter, whether it's the cash price or the copay," said PCMA President and CEO Mark Merritt in a statement.

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CNBC
9/18/2018

The Senate passed a package of 70 bills intended to reduce the misuse of opioids and improve addiction treatment, but critics say the package does not provide sufficient funding to make an impact.

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Senate
9/18/2018

An analysis in Annals of Internal Medicine found that prices rose twice as quickly on drugs that were in short supply compared with drugs for which there was no shortage.

9/18/2018

A draft proposal to crack down on surprise medical bills would prevent health care providers outside of a patient's insurance network from billing for emergency services beyond what the patient's insurance plan allows. A bipartisan group of US senators is working on the measure, which would require health plans to pay limited additional charges and prohibit billing patients extra if they are cared for by an out-of-network physician at an in-network hospital.

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The Hill
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US
9/18/2018

Marco Moran, a pharmacist and co-owner of Mississippi-based pharmacies Medworx Compounding and Custom Care Pharmacy, could face up to 10 years in prison after pleading guilty to attempt and conspiracy to commit health care fraud for his role in a $22 million Tricare fraud scheme. Authorities said Moran's pharmacies submitted more than $22 million worth of fraudulent claims to Tricare and other health care benefit programs for compounded medications generated by paying kickbacks to prescribers from about May 2014 to January 2016.

9/18/2018

Tod Hagins, a doctor from Ohio and operator of Weirton Suboxone Clinic in Weirton, W.Va., received a prison term of four years and nine months after pleading guilty to health care fraud, money laundering and conspiracy to distribute controlled substances outside the bounds of professional medical practice. Hagins, who was ordered to pay $130,160 in a money judgment, admitted to prescribing oxycodone to people who didn't need it in exchange for a share in profits from the sale of the drugs on the street, resulting in improper payments from the state's Medicaid program.

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oxycodone
9/18/2018

Raymond Pellegrino, a chiropractor who operated several practices in Hicksville and West Hempstead, N.Y., could face up to 10 years in prison after being arrested and charged with health care fraud for allegedly defrauding private insurer Anthem Empire Blue Cross Blue Shield. Pellegrino allegedly submitted over $2 million worth of fraudulent claims to Anthem Empire for unprovided osteopathic and other medical services from December 2003 to September 2014, authorities said.