Payer Roundup—Blue Cross Blue Shield Association lawsuit unfolds; Rightway raises $109M; Surescripts reportedly eyes sale

Below is a roundup of payer-centric news for the week of April 1, 2024.

BCBSA and Ford Motor in legal dust-up

The Blue Cross Blue Shield Association (BSBSA) is facing a lawsuit from Ford Motor where a judge has determined the insurer has overcharged the company for commercial health insurance, Reuters reported.

Ford said last year that Blue Cross companies conspire to fix prices. In October, a federal appeals court upheld the company's $2.7 billion antitrust settlement.

"Settling defendants will also agree to make changes in the way they do business that plaintiffs believe will increase the opportunities for competition in the market for health insurance," said BCBSA in a statement on their website.

Earlier this week, Home Depot asked the Supreme Court to review that the $2.7 billion decision does not stop BCBS companies from "receiving exclusive geographic branding rights," reports Becker's.

Rightway PBM raises $109M

Rightway, a pharmacy benefit manager, has raised $109 million, according to a recent Securities and Exchange Commission filing.

The transaction was signed off by CEO Jordan Feldman. Other people mentioned in the filing include Theodore Feldman, M.D., Rightway's chief medical officer, and various board members. The news was first reported by Endpoint News.

Tyson Foods recently switched from CVS Caremark to Rightway for its drug benefits needs.

Report: Surescripts could be sold

Surescripts, an electronic prescribing company half owned by the National Association of Community Pharmacies and the National Association of Chain Drug Stores and half owned by Express Scripts and CVS Caremark, is looking at the possibility of a sale, reports Business Insider.

The company hired investment bank TripleTree to look for buyers, including private equity firms. Its unusual ownership structure could make a sale difficult.

Surescripts was recently sued by the Federal Trade Commission, alleging the company maintained a monopoly status. Prescryptive Health CEO Chris Blackley felt the ruling didn't go far enough, he said in an interview with Fierce Healthcare.

Georgia Medicaid expansion would slash uninsurance rate: study

About 28% of uninsured people in Georgia would gain health coverage, cutting the uninsured number by nearly 300,000 people, if the state expanded Medicaid, a report from the Urban Institute found.

It revealed that low-income, young people and Black and American Indian people would be the most likely to gain health coverage.

Georgia is one of 10 states to not have expanded Medicaid.

Point32Health eliminates home health care prior auth

The parent company of Harvard Pilgrim Health Care and Tufts Health Plan has decided to no longer require prior authorization for its commercial plan members needing home health care services.

Starting April 12, Point32Health instituted new policy utilization is not required for the first 30 days after a member is discharged from a hospital. Services that no longer need approval are physical therapy, speech language services, social work visits, home health aides, skilled nursing and more.

"While prior authorizations are an important tool in helping us keep medical costs as low as possible and ensuring that our members receive high-quality care that is medically necessary, we do not want them to be an impediment,” said Glenn Pomerantz, M.D., chief medical officer at Point32Health, in a statement.

Pomerantz said this decision is part of a more comprehensive review the company is undergoing.

Idaho PBM bill gets national praise from industry groups

The National Association of Chain Drug Stores sung the praises of an Idaho bill designed to reduce prescription drug prices and reform pharmacy benefit managers.

Signed by Gov. Brad Little on April 1, the National Community Pharmacists Association (NCPA) said the bill mandates PBMs to report rebates and use pass-through pricing instead of spread pricing.

"NCPA was pleased to support the bill, which was spearheaded by the Idaho State Pharmacy Association," the group said in a statement.

California health plan partners with Canary Health

Centene subsidiary Health Net and Canary Health, a digital therapeutics company, have partnered to give members an online, six-week, education and support program for caregivers.

The program is available to all 500,000 Health Net enrollees, regardless of which type of health plan an employee has.

"Family caregivers play many roles in the care for their loved ones, which compound the physical and financial strain on themselves, their care recipient, the healthcare system and our economy," said Canary Chief Medical Officer Neal Kaufman, M.D., in a statement. "This often leads to absenteeism at work, and eventually many are forced to leave the workforce."

Elevance Health hands off life and disability business

StanCorp Financial Group, an insurance and financial services company in Portland, Oregon, has acquired the Life & Disability business from Elevance Health.

Terms of the agreement include a 10-year distribution partnership where StanCorp's products will be available to Elevance customers.

“We look forward to our continued partnership with The Standard and value their expertise in the Life & Disability business,” said Morgan Kendrick, executive vice president and president of commercial health benefits at Elevance Health, in a statement. “Together we’re committed to ensuring a seamless transition for the customers we collectively serve.”