Litigation Update: Another Health Plan Lawsuit Alleging Mismanagement by Third Party Administrator

SOURCE: Haynes Boone – December 10, 2024

A recent complaint (“Complaint”) brought by Owens & Minor, Inc., in its capacity as plan sponsor of the Owens & Minor, Inc. Group Health Plan, a self-funded plan (the “Plan”), asserts that the Plan’s third party administrator, Anthem Blue Cross and Blue Shield (the “TPA”), breached its fiduciary duties to the Plan under ERISA. Specifically, the Complaint alleges that the TPA grossly overpaid certain medical claims on behalf of the plan sponsor and also pocketed pharmaceutical rebates that should have been paid to the Plan. 

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Oscar Health CEO – “I Would Eliminate Employer Sponsored Health Insurance”

SOURCE: Finance / Yahoo.com

Oscar Health (OSCR) CEO Mark Bertolini sits down with Seana SmithMadison Mills, and Anjalee Khemlani on Yahoo Finance’s Catalysts, addressing some of the various frustrations Americans have with the state of the US healthcare system.

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Rx Gross To Net

By Christopher V. on Linkedin

What does “Gross to Net” really mean?

Yesterday I posted about the Assistant Secretary for Planning and Evaluation – HHS report on the first two years of RxDC data.

Gross to net in plain terms refers to the difference between a drug’s list price (the sticker price set by the manufacturer) and the actual amount that is paid after discounts, rebates, and other price concessions are applied.

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