Inside an Automated Healthcare Practice: Redesigning Care Around People, Not Paperwork Presented by Greenway Health

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Featured Story   Payday in ‘Pay-for-Delay’ Case The news A jury in federal court in Boston this week awarded nearly $885 million in damages to pharmacies and wholesalers who said they were forced to overpay for a gastrointestinal drug because Takeda Pharmaceutical allegedly kept generic competition from the market. Under federal antitrust law, that award will triple when the court enters into a final judgement of the case. The case Amitiza is a constipation drug that Takeda previously marketed under a partnership with Sucampo Pharmaceuticals. In 2014, Takeda settled with Par Pharmaceuticals, which had sued challenging the drug’s patents. In exchange for a payment from Takeda, Par agreed not to market its Amitiza generic until 2021. Why this matters The Hatch-Waxman Act, passed in 1984, set up the framework for generic drugs. It secured additional protection and patent life for branded drugs and intellectual property associated with them while also giving generic drugmakers a streamlined, less expensive path to seek regulatory approval. Litigation is common, as generic drugmakers challenge the patents of branded drugs. These disputes usually settle, but the deals are sometimes called “pay-for-delay” deals because they keep generic competition from entering the market. While Takeda contends its deal was legal under Hatch-Waxman, the plaintiffs argued otherwise. The jury agreed with the plaintiffs arguments. Soundbite “We remain firm in our conviction that the plaintiffs’ case lacks merit, and we will vigorously pursue post-trial motions and an appeal,” Takeda said. —By Frank Vinluan  Sponsored   Inside an Automated Healthcare Practice: Redesigning Care Around People, Not Paperwork Presented by Greenway Health By reducing administrative burden and redesigning workflows around human needs, it creates space for what matters most: connection between clinicians and patients.  Learn more. Top Stories   Hospitals Take CVS to Court Over Alleged $250M 340B Scheme The lawsuits Three health systems are suing CVS Health, alleging the company and its pharmacy subsidiaries diverted roughly $250 million in savings from the 340B Drug Pricing Program. The health systems — Mount Sinai, Michigan Medicine and the University of Kansas Health System — filed separate lawsuits on Monday. The complaints say that CVS, through its pharmacy benefit manager CVS Caremark and related subsidiaries, set up reimbursement structures that retained the gap between insurer payments and reimbursements passed on to 340B providers. The health systems say this “spread pricing” redirected funds meant to support care for low-income and uninsured patients. The lawsuits allege that this practice resulted in roughly $250 million in diverted funds between 2020 and 2025. What the hospitals are saying Dan Peters, general counsel for the University of Kansas Health System, said that his organization had tried to resolve this issue with CVS in the past. “CVS refused to permit a contractually required audit and terminated our 340B agreement. The 340B program allows hospitals to help serve patients in need. We will work to ensure patients continue to benefit from the program,” he wrote in an emailed statement. A spokesperson for Mount Sinai said the lawsuit seeks to ensure hospitals “are not wrongly skimmed off by for-profit intermediaries,” as well as protect their ability to provide care to vulnerable patients. CVS did not respond to MedCity News’ request for comment. — By Katie Adams Selective Contracting, Network Volatility, and Other Trends Affecting the Overall Dental and Vision Benefits Market The skinny New developments that didn't exist in the market just a few years ago are impacting the way employers and vision and dental care providers operate. The cost pressures on dentists and vision care providers are partly the result of higher tariffs and partly due to workforce changes in the aftermath of Covid. All these trends affect self-insured employers and others providing dental and vision benefits to their employees. Network volatility Employers are contending with dental providers leaving the network, resulting in unhappy employees who can't find a provider near them. Employers think the solution is to find insurance carriers with the biggest network so that the problem is addressed. But that might not be the solution, according to Tiffany Johnson, national associate director for dental and vision at Willis Towers Watson. The reality is that many dentists have left the profession during Covid, creating a national shortage. High costs getting passed to employers and members Since last year, when the Trump administration imposed tariffs on many industries, providers have had to contend with higher costs. A dental provider's instruments cost more today than they did before. The same is true in the vision market where frames costs are higher today. All these higher costs ultimately raise costs for employers and, in turn, members. A move towards value Value-based care dynamics are slowly but surely entering the dental world, which has long been driven by fee-for-service.  — By Arundhati Parmar Medicaid’s Housing Problem Isn’t Placement — It’s What Happens Next The problem Roughly 5% of the population drives nearly half of all Medicaid spending. These are the members most likely to cycle through emergency departments, experience repeated hospitalizations, and struggle with unmanaged chronic and behavioral health conditions. They are also disproportionately likely to experience housing instability, with nearly half living in housing that is unaffordable — and to lose housing even after it has been secured. Why it matters Members experiencing housing instability use emergency departments at rates up to four times higher than the general population and are significantly more likely to require inpatient care. Care continuity breaks down. Costs rise. And the system is forced to start over — often with fewer options and higher stakes. This cycle is not inevitable. But it requires a shift in how housing is approached in Medicaid. What works? Housing interventions are often evaluated at the point of placement — but the cost curve is shaped by what happens in the months that follow. Some organizations are beginning to operationalize this more comprehensive approach. They support high-risk members through the full lifecycle of housing — combining navigation, move-in assistance, and ongoing stabilization support. Early experience suggests that when housing is paired with sustained engagement, members are more likely to remain housed and less likely to return to high-cost settings. — By MedCity Influencer Scott H. Schnell  Video   Video: Interoperability with CEO of Particle Health In this episode, Arundhati Parmar sits down with Jason Prestinario, CEO of Particle Health, to dig into where the U.S. really stands on healthcare interoperability and why it matters so much more than most people realize.

In Other News

What Trends Are Shaping the Dental and Vision Benefits Market? Selective contracting, use of AI, networking volatility and interest in value-based care are some of the larger trends affecting the dental and vision benefits market. Timing Meets Context: Aligning Patients and Providers with AI-Enabled Omnichannel Engagement When awareness is timely, aligned, and delivered through trusted channels, such as EHR systems or digital media, it strengthens every step of the patient journey, especially understanding potential options such as ground-breaking clinical trials or targeted diagnostic testing.

Podcast   MedCity Pivot Podcast: A Conversation About Interoperability with Particle Health’s CEO Jason Prestinario talks about the state of healthcare interoperability today, while also addressing questions about the interoperability lawsuits he and others are involved in against Epic. View Now

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