How healthcare's biggest breaches really started - and what your endpoints need to survive the next one Presented by ManageEngine

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Featured Story   HHS Is Reviving Its 340B Rebate Push — And Providers Are None Too Pleased Let’s try this again HHS unveiled a plan to reintroduce a rebate program for 340B drug discounts last week. The department, through the Health Resources and Services Administration (HRSA), is seeking to replace upfront discounts with rebates for a subset of 340B drugs — and this isn’t the first time. HRSA’s original rebate model was scheduled to go live on the first of the year, but courts blocked implementation before it could take effect, citing procedural and legal issues. Now, HRSA is trying again with a revised pilot program that is slated to start next year. How it works Under HRSA’s new plan, drugmakers would pay providers back after their purchase rather than applying the discount at the point of sale — which shifts the burden of tracking and verifying eligible claims onto hospitals. The new rebate model applies to 25 drugs tied to Medicare's negotiated "maximum fair price" under the Inflation Reduction Act. Some of these include Ozempic, Eliquis, Otezla and Calquence. Notably, none of the drugs on the list are among the key drivers of 340B spending — which tend to be high-cost specialty drugs, often cancer and immunology treatments. How provider groups are reacting Providers are responding to the revised pilot program with concern and frustration. Maureen Testoni, CEO of trade group 340B Health, called it a "flawed approach" that has already failed once, noting that federal courts found HRSA's original attempt likely violated administrative law — and that this could happen again. Another vocal critic of rebates, American Hospital Association CEO Rick Pollack, said his organization is "considering all available options" to stop the pilot from taking effect. He warned that it would saddle already cash-strapped hospitals with new administrative and financial burdens they can afford to take on. “The agency's analysis dramatically understates the true costs of this program, ignoring the hundreds of millions of dollars in compliance expenses, cash-flow disruptions and operational burdens that will inevitably divert scarce resources away from patient care. At a time when many hospitals are already under severe financial strain, this policy will force hospitals in rural and other underserved communities to spend more on bureaucracy and less on the services and care that patients depend on every day,” Pollack’s statement read. — By Katie Adams Sponsored   How healthcare's biggest breaches really started - and what your endpoints need to survive the next one Presented by ManageEngine A clinician's home network, a shared nursing station, a telehealth session: each is now an entry point. Mythos and Frontier AI based exploits compress patch windows to hours. Open source supply chain attacks hide inside your EHR's npm and PyPI dependencies. See what security teams need next. Learn More Top Stories   Supernus, Indivior Put Their Heads Together in CNS-Focused Merger The deal Supernus Pharmaceuticals, whose top product is an attention-deficit hyperactivity (ADHD) drug, is combining with Indivior Pharmaceuticals, maker of a blockbuster medication for opioid use disorder. The two companies call the all-stock deal a merger of equals, forming a larger neuroscience-focused company named Supernus, Inc., led by current Supernus Pharmaceuticals CEO Jack Khattar. The drug lineup Besides ADHD, Supernus Pharmaceuticals’ current portfolio spans Parkinson’s disease and depression. Its post-partum depression drug, Zurzuvae, came from the acquisition of Sage Therapeutics last year. The Sage deal brought a platform technology that could contribute to the pipeline. Khattar said the combined pipeline will also have greater firepower to pursue addition growth opportunities, though specific indications and financial details were not disclosed. Why this matters M&A activity has taken off this year, many of the deals involving big pharma companies scooping up biotech companies for pipeline diversification goals that could cushion the fall off of the patent cliff. The Supernus and Indivior deal shows mid-sized pharmas can get in on the action too. Supernus, Inc. will have a portfolio of 11 commercialized products representing nearly $2.2 billion in annual revenue. Synergies from the deal will lead to an estimated $125 million in annual savings. Soundbite “We view this as being the ideal time for two companies that have done so much, progressed so much, are in a position of strength, getting together and creating a very powerful combination that otherwise would not exist,” Khattar said. —By Frank Vinluan Report: Telehealth Uptake Is Lagging in Rural Areas The skinny Telehealth is often touted as a way to expand healthcare access, particularly in rural communities. However, a new study found that rural populations continue to use telehealth at lower rates than their non-rural counterparts. The findings The study from the Elevance Health Public Policy Institute was published last week and used claims data from Elevance Health-affiliated health plans. The researchers created a sample of adults aged 18 and older who were enrolled in commercial, Medicare Advantage, Medicare Supplement or Medicaid plans. This population consisted of 11.5 million members. The study found that between 2022 and 2025, telehealth accounted for about 5% to 8% of chronic condition visits among patients in non-rural areas, compared with 3% to 5% among those in rural areas. These findings come as previous research shows that people living in rural areas have a higher chronic disease burden than those living in urban areas. Those living in rural areas used telehealth less frequently than those in non-rural areas across all 15 chronic conditions included in the study and across all insurance types. These chronic conditions include diabetes, hypertension, chronic obstructive pulmonary disease and more. Soundbite “Despite the potential for telehealth to mitigate access barriers, lower uptake in rural areas merits further study to determine contributing factors,” the report said. “For instance, people living in rural areas were disproportionately represented in lower socioeconomic status quartiles, which may contribute to reduced telehealth engagement due to barriers such as device availability, internet availability and affordability, and lower digital and health literacy.” — By Marissa Plescia Three Ways Distressed Healthcare Must Evolve Shifts needed For distressed healthcare organizations, the way forward is not another disconnected tool. It requires three shifts: Build a deeply integrated system of action to complete the work. Utilize explainable glass-box AI to make action trusted, auditable, and accountable. Work with accountable partners who deliver outcomes, not just software. Can XAI help? We have achieved unprecedented access to clinical insights using Gen AI and sophisticated analytics. However, a new study from Oliver Wyman reports that while 63% of providers surveyed use advanced AI/automation in some capacity, only 20% to 40% use these tools enterprise-wide. AI can summarize, predict, recommend, and flag, but people still have to validate the output, route the task, correct the record, and make sure the work is completed. This is where explainable AI (XAI) can make a difference. Unlike black-box systems that produce outputs without a clear reasoning path, XAI makes recommendations transparent, traceable, and auditable. In healthcare, it’s important that leaders and care teams understand how an answer was derived, what data informed it, where uncertainty remains, and when human assessment should be applied. This allows connected AI-driven workflows to be trusted, monitored, improved, and scaled. Supporting adherence The intelligence layer of our industry has matured, but it’s clear that healthcare cannot outrun systemic pressures by simply throwing technology at the problem. Even the most advanced AI models will struggle to deliver measurable gains without a connected operating environment and partners held accountable for results. What healthcare needs now is a connected, deeply integrated system of action that works with the system of record to complete work across the enterprise, supported by accountable partners willing to stand behind the outcomes they create. — By MedCity Influencer Sachin K. Gupta Video   Video: What did UHC CEO say in unprecedented meeting with reporters? Debunked: UnitedHealthcare invited reporters and influencers to their Minnesota HQ. Why? Hear the exchange between MedCity editor and the UnitedHealthcare CEO.

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