Imperium Health

Eli Lilly is suing the federal government over how hospitals receive savings in a major federal drug discount program. Lilly’s lawsuit was filed Thursday in a Washington, D.C. district court against the HHS and the Health Resources and Services Administration, which oversees the program, called 340B. The lawsuit seeks a court ruling that Lilly can go ahead with a plan to pay hospitals rebates instead of upfront discounts when they purchase qualifying drugs. https://buff.ly/4fyWmro

The number of measles cases around the world rose by 20% in 2023 compared with 2022, leading to an estimated 10.3 million cases, according to estimates released Thursday by the World Health Organization and the U.S. Centers for Disease Control and Prevention. The surge in the preventable disease was driven by "inadequate immunization coverage," the agencies said in a joint statement.

The AMA has spoken out consistently and forcefully in defense of physicians against violence and verbal mistreatment by patients, families and others. In a Leadership Viewpoints column, former AMA president Gerald E. Haron, MD, explained why threats and intimidation against doctors and health workers must end. In 2020, the AMA House of Delegates adopted a policy to help protect physicians and other health care workers.

The Drug Enforcement Administration and the HHS are extending flexibilities for providers prescribing controlled substances via telehealth for another year, the agencies said Friday. The temporary extension marks the third time regulators have prolonged the pandemic-era flexibilities, which allow providers to prescribe some controlled medications, like Adderall for ADHD or drugs to treat opioid use disorder, without first conducting an in-person evaluation. https://buff.ly/3Zc1tbr

ACO Reach participants racked up CMS $1.64 billion in gross savings and $694.6 million in net savings, the feds announced Nov. 8. Net savings to ACOs are $984.4 million compared to benchmarks, and these savings can be reinvested by the ACOs to improve quality scores further. Nearly three-quarters of all ACOs in the program achieved positive savings. The promising results prompted the National Association of ACOs (NAACOS) to advocate the program’s extension.

Based on the sample results, OIG estimates that 46 percent of the 5,879 hospitals that are required to comply with the pricing transparency rule did not comply with the requirements to make information on their standard charges available to the public.

Immune cells produced during severe COVID-19 infection may shrink tumors. The unexpected mechanism offers a new therapeutic possibility for advanced and treatment-resistant cancers.

An OIG evaluation in 2009 found that Part D paid for drugs for enrollees during Part A skilled nursing facility (SNF) stays, and OIG audits in 2012 and 2019 found that Part D paid for drugs for enrollees receiving Part A hospice care. Part D does not cover drugs for which payment is available under Part A.

A new investigation by the Wall Street Journal reveals a pattern of Medicare Advantage’s sickest members switching to traditional Medicare when they run into roadblocks getting their care covered.