News & Analysis as of

Prescription Drugs Insurance Industry

King & Spalding

District Court Orders CVS Caremark to Pay U.S. Government $95 Million

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On June 25, 2025, Chief Judge Mitchell S. Goldberg of the U.S. District Court for the Eastern District of Pennsylvania issued a ruling in the case of U.S. ex rel. Sarah Behnke v. CVS Caremark Corp. et al., ordering CVS...more

Bricker Graydon LLP

Is My Group Health Plan Covered by State PBM Reporting Laws?

Bricker Graydon LLP on

State laws seeking to regulate pharmacy benefit managers (PBMs) have increased significantly over the past few years. As it stands, all 50 states have laws that regulate PBMs in some way, but all are unique. However, most of...more

Quarles & Brady LLP

Indiana Senate Bill 140 Signed into Law Imposing Reforms on Pharmacy Benefit Managers

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Indiana recently enacted significant new legislation that will impact how pharmacy benefit management services are provided in Indiana. Senate Bill 140 (SB 140), signed into law during the 2025 legislative session, imposes...more

Woodruff Sawyer

Cargo Stock Throughput Insurance for Life Science Companies

Woodruff Sawyer on

In the dynamic world of life sciences, companies face unique challenges in safeguarding their valuable assets. From pharmaceuticals to biologics, medical devices to vaccines, these products often require specialized handling...more

Mitchell, Williams, Selig, Gates & Woodyard,...

National Association of Insurance Commissioners (NAIC) Spring 2025 Meeting Summary

The Mitchell Williams Insurance Regulatory team of attorneys recently attended the National Association of Insurance Commissioners (NAIC) Spring 2025 National Meeting which was held in Indianapolis, Indiana. We have prepared...more

Wiley Rein LLP

[Podcast] Pharmacy Benefit Segmentation: Emerging Models for Health Plans

Wiley Rein LLP on

In this episode of The Wiley Contracting Chronicles, hosts Jordan Ross and Brooke DeLoatch discuss the growing trend of pharmacy benefit segmentation among health plans. They outline three emerging models identified at Wiley:...more

Verrill

The GLP-1 Coverage Conundrum: Managing Costs for Group Health Plans

Verrill on

Many employers are facing challenges in incorporating high-cost GLP-1 medications, such as Mounjaro, Ozempic, Rybelsus, Trulicity, and Wegovy, into their group health plans, as they must balance the cost to the group health...more

Patrick Malone & Associates P.C. | DC Injury...

Better Health Care Newsletter - March 2025

The giant firms  that track trends for big businesses have glum news for all of us: Health care costs are spiking anew this year. The rise, one consultancy predicts, will be the highest in 13 years....more

DLA Piper

Keeping Watch on Medicare: Access Prescription Drug Plans and Premiums

DLA Piper on

The Inflation Reduction Act (IRA) significantly changed the popular Medicare drug programs. While an IRA policy goal is to reduce the out-of-pocket drug spending, beneficiaries may experience higher drug plan premiums and...more

Nelson Mullins Riley & Scarborough LLP

Federal Regulatory Update: CMS Releases CY 2026 Advance Notice for Medicare Advantage and Part D Programs

The Centers for Medicare & Medicaid Services (CMS) has issued the Calendar Year (CY) 2026 Advance Notice, proposing updates to payment policies for Medicare Advantage (MA) and Medicare Part D Prescription Drug Programs. This...more

Sheppard Mullin Richter & Hampton LLP

The Legal and Economic Realities of Medicare Drug Pricing: Navigating Opportunities and Challenges

The rising cost of prescription drugs under Medicare continues to pose significant challenges for seniors, a population that relies heavily on consistent and affordable access to medications. This issue underscores broader...more

ArentFox Schiff

Health Care Providers Navigate Fallout of Major Cyberattack on Change Healthcare

ArentFox Schiff on

Change Healthcare, an affiliate of Optum and UnitedHealth Group, processes more than 15 billion health care transactions annually and touches one of every three patient records. On February 21, Change disconnected its...more

Groom Law Group, Chartered

This Week From the Hill (March 10 – 16, 2024)

Each week while Congress is in session, our Policy team delivers a key update to highlight a topical benefits, health, or retirement news item from the Hill, such as a newly introduced bill, a summary of a committee hearing,...more

Patrick Malone & Associates P.C. | DC Injury...

Better Health Care Newsletter - August 2023

A Social Media prescription from America’s top doctor - Imagine sending your teen-aged kid or grandkid out every day to a full-time job in the tech industry. The hours are flexible, and they say they like it...sort of....more

Wiley Rein LLP

Seventh Circuit Holds Settlement Arising From Alleged False Claim Act Violations Does Not Necessarily Constitute Uninsurable...

Wiley Rein LLP on

The United States Court of Appeals for the Seventh Circuit, applying Illinois law, has held that a $100 million settlement between the United States government and a pharmaceutical company for claims arising under the False...more

Bass, Berry & Sims PLC

OIG Approves Free Drug Program for Ultra-Rare Condition in Advisory Opinion 23-02

Bass, Berry & Sims PLC on

On February 23, the Office of Inspector General (OIG) of the U.S. Department of Health and Human Services issued Advisory Opinion 23-02, approving a pharmaceutical company’s program to provide a free 14-day supply of an...more

Quarles & Brady LLP

The Current State of 340B and What to Expect in 2023

Quarles & Brady LLP on

2022 was an eventful year on the 340B front, packed with updates to consequential litigation, proposed new rules, ongoing uncertainty into the Health Resources and Services Administration's (HRSA) underlying enforcement...more

Verrill

A Last-Minute Gift – Prescription Drug Reporting Grace Period and Good Faith Relief

Verrill on

In a move akin to last-minute gift-giving, the Departments of Labor, Health and Human Services, and the Treasury (the “Departments”) released FAQ 56 on December 23, 2022, which provides relief regarding the Prescription Drug...more

Bressler, Amery & Ross, P.C.

State Regulation of Pharmacy Benefit Managers is on the Rise

Since 2021, in an effort to encourage greater transparency in the prescription drug industry, there has been a national trend toward increased state licensing and regulation of Pharmacy Benefit Managers (PBMs). PBMs are...more

Cozen O'Connor

Ninth Circuit Affirms Application of Goods & Products Exclusion

Cozen O'Connor on

On March 9, 2022, the U.S. Court of Appeals for the Ninth Circuit, in Sentynl Therapeutics, Inc. v. U.S. Specialty Ins. Co, 2022 WL 706941 (9th Cir. Mar. 9, 2022) (applying California law), affirmed a district court’s holding...more

ArentFox Schiff

New York To Regulate Pharmacy Benefit Managers

ArentFox Schiff on

Under legislation signed on December 31 by Governor Kathy Hochul, (S.3762/A. 1396; L2021, ch. 828), all pharmacy benefit managers operating in New York State will be required to register with the State Department of Financial...more

Morrison & Foerster LLP - Class Dismissed

One ESTOPP Shop: The Ninth Circuit Weighs In On The Use Of Equitable Estoppel To Compel Arbitration In Two Recent Decisions

When can you compel arbitration of a putative class action? The law is developing quickly and still doesn’t provide a crystal clear answer. The Ninth Circuit recently weighed in on two cases examining what happens when the...more

Akerman LLP - Health Law Rx

Georgia Leads the Way with Enactment of Pharmacy Anti-Steering Law

With an overwhelming amount of bi-partisan support, on May 7, 2019, Georgia enacted the Pharmacy Anti-Steering and Transparency Act, O.C.G.A. §26-4-119 (the GA Act). The GA Act goes into effect as of January 1, 2020....more

Patrick Malone & Associates P.C. | DC Injury...

Will Rx drug costs fall if U.S. puts squeeze on middlemen and curbs rebates?

The Trump Administration has put out its latest prescription to try to slash out-of-control prescription drug prices: Officials want to call medication “rebates” what they say they’ve really become — “kickbacks” — and crack...more

White and Williams LLP

Covering an American Epidemic: Insurance Coverage Issues Arising out of the Opioid Crisis

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...The opioid crisis gripping the United States is a national tragedy affecting hundreds of thousands of lives, with a significant ripple effect on businesses and public entities. Between 1999 and 2016, opioid overdoses...more

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