National – The Workers' Compensation Research Institute (WCRI) released Hospital Outpatient Payment Index: Interstate Variations and Policy Analysis - The study analyzed payments for common outpatient surgeries across 36 states, spanning data from 2005 to 2023. The findings reveal that hospital outpatient payments for workers' compensation grew at a faster rate in states with charge-based or no fee schedules compared to those with fixed-amount fee schedules. Additionally, payments were significantly higher in states lacking fee schedules.
Drug Channels Institute (DCI) released an analysis highlighting that pharmacy benefit manager (PBM)-affiliated specialty pharmacies control the majority of the specialty drug market. The report reveals that nearly 1,900 accredited specialty pharmacy locations are responsible for approximately two-thirds of prescription revenues from pharmacy-dispensed specialty medications. The analysis also notes the growing presence of provider- and health system-owned dispensing channels, indicating evolving dynamics within this market segment. To learn more, check out this website.
The U.S. Department of Labor launched an opinion letter program to provide clear guidance on federal labor laws across five key agencies: the Wage and Hour Division, Workplace Safety and Health Occupational Safety, Employee Benefits Security Administration, Mine Safety and Health Administration, and Veterans’ Employment and Training Service. The website details how to request an opinion letter, offers tips for writing, and explains the submission process.
Iowa – HB 25-1222 has passed both chambers of the Colorado General Assembly. As a reminder HB 25-1222 aims to preserve healthcare access provided by rural independent pharmacies in Colorado. The bill ensures fair reimbursement rates from pharmacy benefit managers (PBMs), allows the use of private couriers for prescription deliveries, and defines “flex pharmacies” to operate as tele-pharmacies under certain conditions. It also mandates clear audit procedures to protect pharmacies from unfair penalties.
Louisiana – HCR 73 was sent to the Secretary of State, which is the final step in the legislative process for a resolution of this type. The resolution urges the U.S. Congress to address growing concerns around pharmacy benefit managers (PBMs) and their impact on prescription drug affordability and access. Specifically, it calls for increased transparency in PBM operations by requiring detailed reporting of pricing negotiations, rebates, and fees. It also mandates that PBMs pass savings from rebates and discounts directly to consumers and seeks to regulate PBM practices to prevent anti-competitive behavior, such as steering patients toward higher-cost drugs.
Texas – Texas’s special legislative session ended this month, and SB 493 was enacted. As a reminder, SB 493 is designed to safeguard the ability of pharmacists and pharmacies to communicate openly about prescription drug benefits. The bill would allow pharmacists and pharmacies to discuss cost-saving options and provide patients with information on drug pricing and benefits without fear of retaliation or penalties. SB 493 passed both the House and the Senate. As a reminder, SB 493 is designed to safeguard the ability of pharmacists and pharmacies to communicate openly about prescription drug benefits. The bill would allow pharmacists and pharmacies to discuss cost-saving options and provide patients with information on drug pricing and benefits without fear of retaliation or penalties.
Industry Watch: Healthcare News
SCPC Submits Comment Letter to CMS on 2028 Medicare Drug Price Negotiation Implementation
Washington, D.C. (June 25)- SCPC submitted a comment letter to the Centers for Medicare and Medicaid Services (CMS) regarding the agency’s 2028 Medicare Price Negotiation Program draft guidance. On behalf of the Senior Care Pharmacy Coalition (SCPC), we write to comment on the draft Guidance entitled: “Medicare Drug Price Negotiation Program: Draft Guidance, Implementation of Sections 1191 – 1198 of the Social Security Act for Initial Price Applicability Year 2028 and Manufacturer Effectuation of the Maximum Fair Price in 2026, 2027, and 2028.” We appreciate the opportunity to comment on the draft Guidance, particularly to address several considerations for CMS as the agency implements the Manufacturer Transaction Facilitator (MTF) for Part B drugs dispensed by pharmacies in 2028, when several Part B drugs are expected to be subject to Medicare drug price negotiation. To read the full letter, click here.
The White House Can Lower Drug Prices By Fixing The Market, Not Price Controls
Washington, D.C. (June 16)- Why do we have a medical system in this country where too many people can’t get the treatment that they need?” Vice President J.D. Vance posed this question during his recent appearance on This Past Weekend w/ Theo Von — and it cuts to the core of America’s health care challenges. To read the full article, click here.
Trump Team Expected to Unveil Next Steps on MFN Drug Pricing Soon
Inside Health Policy (June 10) - The Trump administration is expected to release more details in the coming days on its plan to lower drug prices by using the most favored policy through a potential Center for Medicare & Medicaid Innovation (CMMI) model, three people familiar with the matter told Inside Health Policy. HHS already made price offers to pharmaceutical companies based on the MFN policy, according to the White House. Check out the full article here.
As drug price target deadline looms, pharma companies weigh options
STAT+ (June 10) - Trump administration officials are expected to release more details on their plan to lower prescription drug prices in the coming days and have been meeting with pharmaceutical industry leaders about the potential impacts. The drug companies, in turn, have been gaming out possible scenarios — and strategizing how they may respond to the White House, five people involved in the planning said. To read the full article, click here.
CVS retains some liability in Omnicare false claims suit, federal judge say McKnight’s Senior Living (June 10)
CVS Health Corp. carries some liability for helping its long-term care pharmacy subsidiary, Omnicare, submit fraudulent drug claims for assisted living and other non-skilled nursing residential long-term care facility residents to the federal government, a federal judge ruled last week. Check out the full article here.
Why CVS, Express Scripts Are Suing Over the Arkansas PBM Law
MedCity News (June 8) - Arkansas became the first state to pass a law banning pharmacy benefit managers from owning pharmacies, aiming to curb their market power and reduce drug costs. But major PBMs like CVS and Express Scripts are suing, claiming the law is unconstitutional. To read the full article, click here. Interested in this topic? Check out these other articles on Insurance Newsnet, Arkansas Times, and National Law Review.
Trump’s MFN Push Sparks Concerns for Generics, Biosimilars Makers
Washington, D.C. (June 2) - Inside Health Policy released an article on the recent Executive Order. The Trump administration’s push to revive the controversial “most favored nation” (MFN) pricing policy -- alongside ongoing uncertainty around tariffs and Medicare drug price negotiations -- is creating deep uncertainty for the future of generic and biosimilar drug development in the United States, Association for Accessible Medicines (AAM) President and CEO John Murphy told Inside Health Policy in a Monday interview.
Stay connected to all relevant information in workers' compensation and pharmacy by subscribing to our weekly newsletter. For the previous wrap-up, please click here.