Senate HELP Committee Chair Bill Cassidy

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Insurers and providers share common concerns about ineligible claims under a federal surprise billing law, bolstering Senate HELP Committee Chair Bill Cassidy’s push for a legislative fix before he leaves Congress, Erin Durkin and Victoria Knight report.

The No Surprises Act, a 2020 statute designed to protect patients fromunexpectedly large bills from emergency rooms and other out-of-network providers, established an arbitration process for payment disputes between providers and insurers. Aflood of ineligible claims is clogging that process — and closed-door meetings convened by Cassidy have put the issue on the table as a shared concern

Cassidy says he’d like to put out legislation before he departs the Senate at the end of the year. While time is running short, the veteran legislator signaled the issue is gaining traction.

“Believe it or not, there’s common ground there,” Cassidy said.

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Hospitals pouring resources into research are turning to biotech firms to help enforce their intellectual property rights, Lauren Castle reports.

This trend is being driven by legal and financial barriers hospitals face when protecting their innovations. Public hospitals risk waiving their sovereign immunity. Other medical centers face the risk of alleged infringers arguing that an import ban would harm the public. Before the US International Trade Commission, biotech firms are better positioned to show that they make US products that could be harmed by imports of infringing products.

And then there’s the money. Biotech companies are willing to protect their products even if there’s no immediate return on investment via monetary damages, which is not nearly as easy for medical centers balancing tight budgets. “They got more money than God, so they’re willing to throw that at litigation,” said Raymond L. Panneton of Shackelford McKinley & Norton.

Brigham and Women’s Hospital and biotech firm Seer’s allegations before the ITC and in Illinois federal court against Nanomics Biotechnology illustrate this trend. The hospital and company are waiting to see if the trade commission will block Chinese firm from importing its proteomics kits.

Photographer: Dimas Ardian/Bloomberg

The top pharmaceutical industry lobbying group sued the Trump administration over its Medicare pricing model that seeks to align US drug prices with cheaper ones paid abroad, Nyah Phengsitthy reports.

The Pharmaceutical Research and Manufacturers of America filed suit in federal court in Washington, alleging the government exceeded its statutory authority and violated the Constitution when it recently rubber-stamped the model. The demonstration — set to start Jan. 1 — would test whether alternative methods for calculating Medicare Part B medicine rebates, based on international pricing metrics, will reduce drug costs.

Federal courts blocked President Donald Trump’s first attempt in 2020 to propose a most-favored-nation pricing model. CMS said it can implement the latest demo under Section 1115A of the Social Security Act, which allows it to test new payment models to reduce costs and improve care quality. PhRMA disagreed in its filing.

“The policy doesn’t make medicines more affordable for most beneficiaries, while putting future medical innovation and patient access at risk,” Stephen J. Ubl, president and CEO of PhRMA, said in a statement.