In this edition:

• 🔻 CMS negotiates lower drug prices for first time

• ⚖️ Healthcare plan lawsuits ramp up

• ☄️ Aetna president fired

• 💻 Cybersecurity help for small hospitals

• And more!

CMS negotiates lower drug prices

CMS announced the agreed-upon lower prices for all 10 drugs selected for price negotiations under the Inflation Reduction Act (IRA).

These drugs are considered some of the most expensive and frequently dispensed throughout the Medicare program.

According to CMS, the negotiated prices will allow Medicare patients with conditions like heart disease, diabetes, and cancer to access their medications more cost-effectively.

Previously, these medications accounted for $56.2 billion in total Part D gross covered prescription costs or about 20% of total Part D gross covered prescription costs.

Patients were spending nearly $18.9 billion in out-of-pocket drug costs for all drugs covered under Part D, including $3.9 billion in out-of-pocket costs for drugs selected for negotiation.

Healthcare plan lawsuits increase

Lawsuits alleging employers and health insurance companies shirked their duty to oversee costs are on the rise amid increased price transparency and public outcry against high medical expenses.

A lawsuit filed by a Johnson & Johnson employee in New Jersey federal court earlier this year argued the company violated its obligation to act in the best interest of workers under federal benefits law by overpaying its pharmacy benefit manager for generic specialty drugs available at lower cost elsewhere.

But others from the Kraft Heinz Co., to the Mayo Clinic, to Aetna Life Insurance Co. have also become parties in this emerging arena of medical-cost fiduciary litigation.

The range of lawsuits alleging failure to meet fiduciary duties under the Employee Retirement Income Security Act are broad in scope, and pit employees against employer plan sponsors, and both employers and workers against insurance companies.