Articles and Blogs

It’s no April Fools’ joke. On April 1, 2019, the Health Resources & Services Administration Office of Pharmacy Affairs (“HRSA”) unveiled a long-awaited website that gives providers participating in the 340B drug pricing program (“340B Program”) direct access to information about the maximum amounts that pharmaceutical companies may charge for certain drugs. This moves... READ MORE

Conversation Shifts Back to Health Care in Washington Health care became a major discussion point for lawmakers after this week started with the Trump administration’s declaration that it supports a federal judge’s ruling that the entire Affordable Care Act (“ACA”) should be thrown out. This signals a shift in the Justice Department’s prior position... READ MORE

On December 27, 2018, a federal judge ruled in favor of hospital associations and hospitals challenging the reduction in reimbursement for drugs purchased at a discount under the 340B Program established in the 2018 Outpatient Prospective Payment System final rule (“2018 OPPS Rule”). Judge Rudolph Contreras of the United States District Court in Washington,... READ MORE

Congress Unlikely to Make Progress on Health Care Bills Before Year-End  As government funding battles overtake Capitol Hill, it appears Congress will not use the lame duck to resolve outstanding health care issues. While the desire to steer clear of health care fights is something different from prior years, outgoing House Ways and Means... READ MORE

Democrats Set to Control Key Health Committees in Next Session of Congress The Democratic takeover of the House of Representatives following the recent midterm elections will significantly change the political landscape for health care issues when lawmakers return for the 116th Session of Congress next year. Overall, the election results will mean divided government... READ MORE

Hospitals Release Voluntary 340B Principles as Alternative to Legislation The battle over 340B continued this week as hospital groups announced a new voluntary 340B reporting program as an alternative to congressional legislation that would further regulate the program. Under the American Hospital Association-led initiative, hospitals would commit to publicly disclosing their 340B savings annually.... READ MORE

On August 7, 2018, the Centers for Medicare & Medicaid Services (“CMS”) issued a Memorandum (“Memorandum”) announcing a policy change to allow Medicare Advantage (“MA”) plans to implement step therapy programs for physician-administered and other Part B drugs. Step therapy is a type of prior authorization for drugs in which a health plan requires... READ MORE

On July 25, the Centers for Medicare & Medicaid Services (“CMS”) issued its 2019 Outpatient Prospective Payment System (“OPPS”) Proposed Rule (“OPPS Proposed Rule”). As anticipated based on public comments made by Department of Health and Human Services (“HHS”) Secretary Alex Azar, CMS is proposing to expand application of reduced payment for discounted drugs... READ MORE

CMS Releases 2019 Proposed Medicare’s Physician Fee Schedule  On July 12, the Centers for Medicare & Medicaid Services (“CMS”) announced numerous new policy proposals in a proposed rule to update payment policies, payment rates and quality provisions for services furnished under the Medicare Physician Fee Schedule (“PFS”) for 2019. The annual update reduces payments... READ MORE

On June 12, 2018, the Wisconsin Court of Appeals (“Court”) affirmed a decision by a Wisconsin circuit court and held that a family planning clinic with multiple locations in Wisconsin (“Provider”) was not required to repay the Wisconsin Department of Health Services (“DHS”) a total of $185,074.80 related to Medicaid fee-for-service claims submitted for... READ MORE