No Surprises Litigation – A federal appeals court ruled against HHS regarding the No Surprises Act (NSA). The court ruled that the qualifying payment amount (QPA) which is central to disputes between insurers and providers in out-of-network billing disputes. HHS can appeal but in the interim dispute resolution may temporarily halt.
Shift in PBM Usage – A survey of employer clients by the National Alliance of Healthcare Purchaser Coalitions found that the share of employers using the Big Three PBMs (Caremark, Express Scripts, Optum) declined from 63% to 54%. Furthermore, the survey revealed that more employers are expected to shift away from the Big Three in coming years. You can read the survey here.
Medical Device Tariffs – Bank of America Global Research found that hospitals expect, on average, roughly a 5.6% increase in medical device costs due to tariffs. Medical devices are currently subject to a Section 232 tariff investigation, meaning that the administration is considering imposing far higher tariffs on medical devices than those currently being imposed. The Washington Post reported that the decision is expected within the next month.
Congress Update: Both the House and Senate are on recess until after Labor Day. Before leaving town, the Senate passed a budget bill that, if passed by the House, would fund the government until after the midterms. In other words, don’t expect significant congressional activity until November or December.
