Payer Roundup—CMS delays 340B rule … again; BCBS feuds with Mississippi hospital

Prescription Drugs and Money image
Five physicians at a Pennsylvania opioid addiction treatment practice were indicted for unlawfully dispensing controlled substances. (TaxRebate.org.uk)

CMS delays 340B rule … again

The Centers for Medicare & Medicaid Services proposed a one-year delay for new drug ceiling prices under the 340B drug discount program. If finalized, it would be the fifth such delay. 

Hospital groups were quick to hit back. 

"We have waited too long for simple measures to hold drugmakers accountable in the 340B program," America's Essential Hospitals said in a statement. "Federal scrutiny of manufacturer pricing practices has found overcharges in the 340B Drug Pricing Program. These overcharges undermine the program’s ability to make drugs affordable for vulnerable patients and increase costs for their hospitals, which already operate with thin margins."

The delay comes as hospital groups, including the AEH, are fighting the agency in court over Medicare cuts to 340B hospitals. (Federal Register)

Mississippi hospital vs. BCBS

A Mississippi hospital plans to end its contract with Blue Cross & Blue Shield next month unless the insurer makes major changes to specific language in its contract. 

The University of Mississippi Medical Center said its current contract allows the insurer to modify financial terms without notice. Predictably, Blue Cross has pointed the finger back at the hospital, according to the Clarion Ledger. 

Both companies experienced a similar standoff in 2013, which then-Gov. Phil Bryant helped settle. 

Unless the two organizations can come to an agreement, the contract will end June 30. (Clarion Ledger)

Five physicians in cuffs for Medicare/Medicaid fraud

Five Pennsylvania physicians have been indicted for unlawfully dispensing controlled substances and health care fraud, the Department of Justice said Thursday. 

The physicians, from Redirections Treatment Advocates, LLC, an opioid addiction treatment practice, are accused of creating and distributing prescriptions of buprenorphine, a drug used to treat addiction. The five also allegedly caused fraudulent claims to be submitted to CMS for payment to cover the costs of the medication.

“Today we are facing the worst drug crisis in American history, with one American dying of a drug overdose every nine minutes,” Attorney General Jeff Sessions, said in a statement.  “It's incredible but true that some of our trusted medical professionals have chosen to violate their oaths and exploit this crisis for profit."

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