White House Announces Drug Pricing Deal with Major Pharmaceutical Company
The White House announced an agreement between the United States and Pfizer to bring American drug prices in line with the lowest paid by other developed nations (the most-favored-nation, or “MFN,” price). According to the White House, the agreement will, among other things, provide every State Medicaid program access to MFN drug prices on Pfizer products, requires Pfizer to repatriate increased foreign revenue on existing Pfizer products, and requires Pfizer to offer medicines at a deep discount off the list price when selling directly to American patients.
OIG Reports on Unallowable Charges for Trauma Team Activations in Hospitals
The Department of Health and Human Services Office of Inspector General (“OIG”) reported that CMS made Medicare payments to trauma centers for trauma team activations that did not comply with Federal requirements. According to the Audit Report, 100 of 125 sampled claims had unallowable trauma team activation charges that totaled $728,468.00. Additionally, HHS-OIG estimated that hospitals billed approximately $2.4 billion in unallowable charges for trauma team activations that did not meet Medicare requirements from January 1, 2020 through June 30, 2022. HHS-OIG recommended that CMS, among other things, work with the MACs to identify similar instances of non-compliance, revise CMS guidance to explain when trauma care activation is reasonable and necessary, and provide more frequent education to hospitals on CMS requirements for submitting claims with trauma care activation.
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