Sunday, August 31, 2008

Happy Labor Day Weekend!

I hope that everyone is enjoying the Labor Day weekend and that Gustav spares New Orleans.
  • OPM issued final regulations for the Federal Employees Dental / Vision Program last week. OPM provided the following clarification:
    A comment indicated that it was not clear whether enrollment or coverage
    would be denied for preexisting dental conditions. Under this Program, neither enrollment nor benefits coverage is denied due to a preexisting dental condition. However, since the dental program was established in order to provide benefits for dental services for teeth and their surrounding tissues, a carrier may determine that coverage does not extend to replacements for teeth missing before the effective date of enrollment in the Program.
    It's a fun fact to know and tell that OPM's FEHBP regulations (5 C.F.R. § 890.201(b)(5)) exempt dental benefits (and cosmetic surgery) from its general prohibition against pre-existing conditions.
  • OPM also has posted an RFP for the Federal Long Term Care Insurance Program Carrier. The current carrier is Long Term Care Partners. The incumbent's initial contract is approaching the end of its seven year term. According to the statistics accompanying the RFP, there are about 220,000 people enrolled in the Program. Proposals currently are due on November 14, 2008.
  • The Office of the National Coordinator for Health Information Technology has announced that it will be holding a Medical Identity Theft Townhall on October 15, 2008, from 8:30 am to 4:30 pm at the FTC Conference Center, 601 New Jersey Ave, NW, in Washington. You must RSVP to and indicate whether you are planning to attend in person or by webcast.
  • According to a National Quality Forum press release, the NQF has endorsed nine new national voluntary consensus standards for health information technology (HIT) in the areas of electronic prescribing, electronic health record (EHR) interoperability, care management, quality registries, and the medical home. These HIT structural measures are intended to help providers assess the efficiency and standardization of current HIT systems and identify areas where additional HIT tools can be used.
  • One of the most pointless lawsuits in my opinion is the Average Wholesale Price RICO class action against First Databank and McKesson pending in the federal district court for the District of Massachusetts. Lawyers for First Databank and the plaintiffs negotiated a class action settlement that would have disrupted the PBM market for health plans. The court rejected the settlement because, among other reasons, it provided no financial relief to the class members. The parties returned with another settlement that provides modest financial relief to consumers, but none to the health plans that paid most of the freight. The court is considering this proposal. Meanwhile, McKesson has defended itself against the plaintiff's complaint.

    Meanwhile, it turns out that the plaintiffs last year filed a separate federal antitrust class action against McKesson based on the same allegations == that McKesson and First Databank conspired to artificially increase the AWP which many PBMs and health plans use to set their negotiated prices. Last week, U.S. District Judge Patty Saris, who also is hearing the RICO action, dismissed the antitrust action on the ground that the plaintiffs failed to demonstrate the antitcompetitive effect of McKesson's alleged misconduct. It will be interesting to follow the second bounce of this ball.

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