Tuesday Tidbbits

According to Hartford Business, Cigna and Express Scripts extended the December 8, 2019 deadline for closing on their merger deal by six months as they still have some state regulatory hurdles to clear. The parties nevertheless expect the deal to close before the end of this year.

The Centers for Medicare and Medicaid Services announced a proposed rule that would give Medicare Part D and Medicare Advantage plans more bargaining power to lower prescription drug costs. The proposed changes include:

• Providing Part D plans with greater flexibility to negotiate discounts for drugs in “protected” therapeutic classes, so beneficiaries who need these drugs will see lower costs;
• Requiring Part D plans to increase transparency and provide enrollees and their doctors with a patient’s out-of-pocket cost obligations for prescription drugs when a prescription is written;
• Codifying a policy similar to the one implemented for 2019 to allow “step therapy” in Medicare Advantage for Part B drugs, encouraging access to high-value products including biosimilars; and
• Implementing a statutory requirement, recently signed by President Trump, that prohibits pharmacy gag clauses in Part D.

CMS is also considering for a future plan year, which may be as early as 2020, a policy that would ensure that enrollees pay the lowest cost for the prescription drugs they pick up at a pharmacy, after taking into account back-end payments from pharmacies to plans.

Healthcare Dive offers an interesting analysis of the proposed rule here.

In a hopeful step, America's Essential Hospitals, a trade association of tertiary care hospitals, now offers providers an online toolkit to help them hold cost of care discussions with patients. The toolkit should prove helpful to health plans too. Bravo.

Yesterday, HHS's Office for Civil Rights, which enforces the HIPAA Privacy and Security Rules, announced a HIPAA privacy rule breach settlement with a small Hartford, CT, medical practice.

In February 2015, a patient of Allergy Associates contacted a local television station to speak about a dispute that had occurred between the patient and an Allergy Associates’ doctor. The reporter subsequently contacted the doctor for comment and the doctor impermissibly disclosed the patient’s protected health information to the reporter.  

The practice agreed to pay OCR $125,000 and commit to a corrective action plan.