In this edition:

• 💊 Wells Fargo sued over pharmacy benefits

• 🐷 Rural care improvement through tech and policy

• 🤝 Medicare drug negotiations near end

• 💵 Staying ahead of costs

• And more!

Wells Fargo sued over pharmacy benefits

Wells Fargo & Company, including executives at the bank who were fiduciaries to the plan, have been accused in a lawsuit of breaching duties under ERISA by mismanaging the firm’s health plan in a way that caused employees to overpay for prescription drugs. 

The lawsuit, Navarro v. Wells Fargo & Co., was filed Tuesday in a U.S. district court in Minnesota by four former participants of the ERISA plan at issue.

The plaintiffs’ suit claims that Wells Fargo agreed to pay its Pharmacy Benefits Manager high prices for generic drugs that were “widely available at drastically lower prices.” 

According to an example laid out in the lawsuit, someone with a 90-unit prescription for the generic drug fingolimod—the generic form of Gilenya, used to treat multiple sclerosis—could fill that prescription without insurance at Wegmans for $648, ShopRite for $677, Rite Aid for $891 and Walmart for $895. The lawsuit alleged that Wells Fargo agreed to make the plan and its participants and beneficiaries pay $9,994.37 for each 90-unit fingolimod prescription. 

Improving rural care with tech and policy

Rural health care providers face a trifecta of pain points: limited access to care, difficulty in delivering high-quality services, and financial constraints.

The shortage of health care professionals is particularly acute, with nurses and physicians often drawn to urban areas by higher salaries and more resources.

To address these challenges, we need a multi-faceted approach involving policy changes and technological innovation.

Policy interventions:

• Enhanced reimbursement rates for rural health care providers to ensure financial viability

• Expansion of loan forgiveness programs for medical and nursing students who commit to practicing in rural areas

• Increased federal and state funding for rural health care infrastructure and technology

Technology opportunities:

• Telemedicine: COVID-19 demonstrated that telehealth can provide quality care and improve access to specialists.

• Interoperability: Seamless sharing of medical data is crucial for coordinating care between rural providers and urban specialists.

• AI and ambient listening tools: While potentially beneficial, these must be implemented thoughtfully to ensure they truly save time for clinician

Medicare drug negotiations wrap up

The first round of the Biden administration’s Medicare drug price negotiations is nearly finished, with two major deadlines approaching. 

President Joe Biden’s signature Inflation Reduction Act gave Medicare the power to directly hash out drug prices with manufacturers for the first time in the federal program’s nearly six-decade history.

That process aims to make expensive medications more affordable for older Americans, but the pharmaceutical industry argues that it is a threat to their revenue, profits and drug innovation. 

The negotiation period officially ends next Thursday. Medicare will publish the final agreed-upon prices for the medications by the beginning of September, though the exact timing is still unclear. 

Those prices will go into effect in 2026.