Deadline for Submitting Gag Clause Attestation Is Dec. 31, 2024

By Bolton • December 5th, 2024 SOURCE: https://www.boltonusa.com/deadline-for-submitting-gag-clause-attestation-is-dec-31-2024/

Effective in 2020, the Consolidated Appropriations Act, 2021 (CAA) prohibits health plans and health insurance issuers from entering into contracts with health care providers, third-party administrators (TPAs) or other service providers that contain gag clauses (i.e., clauses restricting the plan or issuer from providing, accessing or sharing certain information about provider price and quality and de-identified claims).

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Are You NADAC Ready? Staying Ahead of the Drug Pricing Landscape

NADAC pricing is gaining traction in the PBM industry due to its role in pricing transparency, reimbursement negotiations, cost management, formulary management, regulatory compliance, and alignment with industry trends. It offers a standardized benchmark for drug pricing, promoting fairness and transparency in the healthcare system.

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FTC Report on PBM Consolidation

FTC Releases Interim Staff Report on Prescription Drug Middlemen

Report details how prescription drug middleman profit at the expense of patients by inflating drug costs and squeezing Main Street pharmacies…….details how increasing vertical integration and concentration has enabled the six largest PBMs to manage nearly 95 percent of all prescriptions filled in the United States.

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Class Action Lawsuit Challenges Noncoverage of Obesity Drugs

This case is about disability discrimination in the provision of healthcare coverage. Specifically, this case is about a health insurance company’s categorical exclusion of prescription medication for the treatment of obesity and the resultant discrimination against people with the disability of obesity.”

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