Wednesday, March 23, 2016

Midweek Update

On Monday, we learneded that Anthem Blue Cross has sued its prescription benefits manager Express Scripts. According to the LA Times, Anthem is
alleging that the latter owes it at least $13 billion, and as much as $14.8 billion, in undelivered savings from negotiating lower prices on prescription drugs for Anthem's customers. The filing is assumed by observers to be the final break after attempts at working things out failed. Earlier this year, Anthem Chief Executive Joseph Swedish told an investment conference that his company was overpaying for drugs by $3 billion a year, and blamed Express Scripts.  Express hasn't responded to the lawsuit in court, but in statements its spokesmen have said Anthem had "mischaracterized" its obligations and that the lawsuit is "without merit."
The case was filed in federal district court in Manhattan.   Anthem is Express Scripts' largest customer.  "Industry observers believe that the lawsuit's aim may be to unwind the two companies' partnership, which is due for renewal in 2019." This is worth following.

In a more mundane bit of analysis, the Drug Channels blog comments here on Express Scripts' recent utilization report.

On Monday, the HHS Office for Civil Rights, which enforces the HIPAA Privacy and Security Rules, announced a second phase of compliance audits which will encompass not only HIPAA covered entities but also their business associates.  The announcement explains the audit process, including how companies will be selected for audit.

The Wall Street Journal reports that health systems are now investing in urgent care centers as their popularity steadily grows.  "For patients, urgent-care centers connected to a health system offer the dual benefit of convenient care and some assurance that they can be quickly transferred to an emergency room or referred to a primary-care doctor or specialist. Conversely, hospitals can steer patients in crowded ER waiting rooms to an affiliated urgent-care center nearby if it isn’t a true emergency." It will be interesting to see whether the telemedicine push will impact this urgent care center growth.

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