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On May 18, 2016, the Department of Health and Human Services (“HHS”) published a final rule to implement Section 1557 of the Affordable Care Act (“ACA”), which prohibits discrimination in health coverage and care based on race, color, national origin, age, disability and sex.  These provisions incorporate existing federal non-discrimination law and policy and also […]

One of the most important contractual elements in a Pharmacy Benefit Manager’s (“PBM”) service agreement that is used in pharmacy benefit cost reduction is the definition  and utilization of the MAC (“Maximum Allowable Cost”) list.  The MAC generally refers to a PBM-generated list of products that includes the upper limit or maximum amount that a […]

As if these dire warnings should come as any surprise, insurers who are providing health insurance coverage in the public exchanges are sounding the alarm! WARNING: LOSSES UNDER OBAMACARE ARE UNSUSTAINABLE! Really? How could there be any other outcome? A completely overblown healthcare “crisis” was addressed through mandated coverage that had to be over-priced in […]