Utilization review, HIPAA updates and more
Nick Hut talks with HFMA’s Kathy Stull about the Medicaid work requirement and 340B developments. Erika Grotto discusses utilization review with Kevin Coloton, CEO of HURC and HIPAA updates with Jon Bilotti, enterprise technology consultant at BCS365.
340B bill would levy various restrictions on participating hospitals
Legislative language overhauling the 340B Drug Pricing Program faces a long and uncertain path in Congress but would have significant implications if some of the provisions become law. A preliminary bill draft released by Sen. Bill Cassidy (R-La.) would tighten oversight of hospitals and contract pharmacies, increase transparency and require 340B discounts to be transferred…
Update: Litigation about the 340B program’s ‘patient’ definition could affect hospital savings
Note: This story is an update to prior coverage. Providers weighing in on potentially disruptive litigation involving the 340B Drug Pricing Program say a ruling in favor of the drug manufacturer would have substantial implications for the program. In a case brought by AbbVie Inc. against the federal government, the central question concerns the definition…
340B rebate model pilot advances as providers warn of added costs
The Health Resources and Services Administration (HRSA) continues to take steps toward implementing a rebate model for the 340B Drug Pricing Program. After soliciting comments on a planned model over a two-month period, HRSA sent an updated notice May 27 to the Office of Management and Budget (OMB) for a review that remains ongoing. That…
Hospitals, insurers clash on 340B rebate costs
Hospitals and insurers both urged federal regulators to ignore the cost projections of the other side in their comments on a coming redux of a 340B rebate model. The comments came in response to a request for information (RFI) from the Health Resources and Services Administration (HRSA) seeking input on whether and how to implement…
Federal 340B overhaul bill unlikely this year
A bipartisan Senate effort at 340B program reform is likely dead this Congress, according to lobbyists and policy watchers. The so-called gang of six group of senators has been working on an overhaul of the program since 2024 that aims to address concerns of both providers and drugmakers. However, that effort has not advanced beyond…
How a looming federal mandate will affect hospitals
Nick and Shawn discuss appropriations efforts and how various provisions will affect hospitals, specifically in outpatient department claims. Note: After the recording of this episode, the parties hit a roadblock on the bill that was the main topic of discussion. Check out our news coverage for the latest.
340B program changes in 2026 test compliance, cash flow and margins
Beyond a high-profile legal battle over a rebate pilot, a range of changes are poised to hit the 340B program in 2026, say policy watchers. The latest development came Jan. 15 when Eli Lilly expanded its requirements for covered entities to submit claims-level data for its own pharmacies, in addition to previously requiring that data…
FastFinance: Texas sues Epic; 340B lawsuit update
HFMA’s FastFinance newsletter is now a podcast. Host Rich Daly discusses the most current and relevant healthcare news, delivered in an easily digestible format. A list of alleged financial harms against hospitals are at the heart of Texas’ anticompetitive lawsuit again EHR vendor Epic. Learn why its details are required reading. Also, this week’s Weird…
Health systems face margin cuts of up to 13 percentage points in next 5 years, McKinsey analysis shows
A combination of federal policy changes and industry trends could cut health systems' margins by up to 13 percentage points in the next five years, according to a McKinsey analysis.