News for Insurers
Top stories summarized by our editors
5/23/2017

President Donald Trump's 2018 budget request calls for relaxed restrictions on pre-approval communications between payers and drug or device makers and implies that the FDA should also loosen restrictions on off-label marketing.

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President Donald Trump, FDA
5/23/2017

The Nevada Senate approved a bill requiring makers of diabetes drugs to disclose costs and pricing histories, and to notify the state and insurers before raising prices by more than the inflation rate. The California Senate approved a bill restricting gifts, flights, speaking and consulting fees, and other forms of payment from drugmakers to health care providers.

5/23/2017

A new law in New York allows regulators to conduct cost-benefit analyses of prescription drugs if total prescription drug spending under Medicaid exceeds the medical inflation rate plus 5%.

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Kaiser Health News
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inflation rate
5/23/2017

The UK Competition and Markets Authority says Merck Sharp & Dohme may have used a discount program for Remicade, or infliximab, to deflect competition from biosimilar versions of the drug.

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Reuters
5/23/2017

Sherry Ma, a Ladue, Mo.-based physician, and her employer, Aima Neurology, have agreed to pay $291,288 as part of a civil settlement to resolve accusations of fraudulently billing the Medicare program. Ma was accused of submitting false Medicare claims for new vials of Botox and Myobloc when she actually used unfinished vials obtained at no cost for procedures on privately insured patients, authorities say.

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Sherry Ma, Aima Neurology
5/23/2017

Anne Marie Coke of Marshall, Mo., was sentenced to 30 years in prison after pleading guilty to 36 felony charges, including 33 counts of fraudulently attempting to obtain a controlled substance. Coke, who entered a plea deal in return for 109 other charges being dropped, stole pre-signed prescription forms from the dental office where she worked and filled out fraudulent oxycodone prescriptions for herself and others, according to testimony.

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Anne Marie Coke, oxycodone
5/23/2017

Tammy Bolles, a personal assistant services provider from Lincoln, Neb., was arrested and charged with theft by unlawful taking in an alleged Medicaid fraud. According to a court document, Bolles was overpaid $9,596.32 by Nebraska Medical Assistance after falsely claiming that she spent over 400 hours with two patients over a two-year period while she was actually working at a department store.

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Tammy Bolles
5/23/2017

Shana Clay, a resident of Chattanooga, Tenn., was charged with three counts of TennCare fraud by doctor shopping. Clay is accused of visiting multiple physicians and using her TennCare benefits to obtain prescriptions of hydrocodone and Tramadol, authorities say.

5/22/2017

Minneapolis now ranks as the fittest city in America, ending Washington, D.C.,'s three-year reign as it drops to the second spot, followed by San Francisco and Seattle, according to an annual list from the American College of Sports Medicine and the Anthem Foundation. The report, which considered long-term health indicators such as chronic disease and smoking rates, ranked Indianapolis, Oklahoma City and Louisville, Ky., as the least fit of the 50 metropolitan areas included.

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The Hill
5/22/2017

A hearing today may shed light on the future of the Affordable Care Act's cost-sharing reduction payments after a lower court ruled that the payments were not authorized, a decision that was appealed by the Obama administration. It's not clear whether the Trump administration will allow the case to proceed, ask for a delay or withdraw the appeal.

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USA Today, Politico