Modern Healthcare - - LATE NEWS -

A fed­eral judge last week tem­po­rar­ily pro­hib­ited Arkansas from block­ing Med­i­caid pay­ments to Planned Par­ent­hood, ex­pand­ing her or­der re­quir­ing the state to con­tinue pay­ing for ser­vices for three pa­tients who had sued over the move. Repub­li­can Gov. Asa Hutchin­son last year ter­mi­nated the or­ga­ni­za­tion’s Med­i­caid con­tract be­cause of se­cretly recorded videos made by an anti-abor­tion group. Planned Par­ent­hood praised the rul­ing. At­tor­ney Gen­eral Les­lie Rut­ledge, a Repub­li­can, said she was dis­ap­pointed with the de­ci­sion.

Some state of­fi­cials want to opt out of a CMS rule ef­fec­tive this week that requires them to as­sess how easy it is for fee-for-ser­vice Med­i­caid ben­e­fi­cia­ries to re­ceive pri­mary care and pre- and post-natal ob­stet­ric ser­vices and see spe­cial­ists and be­hav­ioral health ex­perts, among other ser­vices. Scof­flaws could see their fed­eral funds with­held if they don’t com­ply. States with at least 90% of ben­e­fi­cia­ries in man­aged care, like Florida, say there’s no point in spending the time to con­duct the as­sess­ment of its Med­i­caid pop­u­la­tion. In the fi­nal ac­cess rule, the CMS es­ti­mated it could take states as long as 15,000 hours to de­velop the plans. Ten­nessee was suc­cess­ful in get­ting a pass on the rule be­cause its fee-for-ser­vice en­rollees gen­er­ally had other forms of cov­er­age such as Medi­care, ac­cord­ing to Med­i­caid spokes­woman Sarah Tanksley.

Hori­zon Pharma will pay $65 mil­lion to settle a law­suit over $166.2 mil­lion in re­bate pay­ments that Ex­press Scripts said it was owed from Hori­zon. The set­tle­ment comes af­ter Hori­zon coun­ter­sued Ex­press Scripts, con­test­ing the amount owed and al­leg­ing a breach of con­tract by the phar­macy ben­e­fit man­ager. The suit re­lates to re­bates for Duexis, Rayos and Vi­movo, which are some of Hori­zon’s most pop­u­lar drugs and are used to treat rheuma­toid arthri­tis and os­teo­poro­sis, among other dis­eases. Nei­ther party will ad­mit any fault or wrong­do­ing in the set­tle­ment. The drug­maker ex­pects to record the pay­ment as a re­duc­tion in sales rev­enue in the third quar­ter of this year.

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