Johnson & Johnson has sued divisions of health insurer Cigna, accusing them of working with a drug-benefit middleman to drain J&J financial-assistance funds earmarked for patients taking some of its pricier drugs. The move by J&J widens litigation the healthcare giant initiated in 2022 against a middleman, SaveOnSP LLC, and is a new flare-up of long-running tension over drug prices among manufacturers, insurers, pharmacy-benefit managers and other middlemen in recent years. J&J added Express Scripts, which is a PBM, and specialty pharmacy Accredo—both units of Cigna—as defendants in an amended lawsuit that J&J filed under seal in federal court in New Jersey earlier this year. The amended lawsuit was unsealed in late November. The pharmaceutical company claims that the Cigna units worked on a program with SaveOn that caused J&J to pay more than $100 million in drug copay assistance than it would have otherwise. J&J is seeking monetary damages in an amount to be determined at trial, and a court order that the companies stop the program.
Anger toward health insurers reflects people's 'pent-up pain'
In the aftermath of UnitedHealthcare CEO Brian Thompson's fatal shooting, an outpouring of rage at the U.S. health care system has risen to the surface.
Social media posts have ranged from mournful to apathetic to joyful, including morbid celebrations of Thompson’s death. That deluge has forced people across the country to grapple with two heavy subjects at once: the callousness of a slaying, and an undercurrent of deep-seated anger at a health care industry that makes a lot of money by exploiting Americans.
“People feel there is an inherent unfairness in the way that the system works,” one advocate said. “That someone who has health insurance gets sick and then it’s a company, a business, that can be the barrier to them accessing the care they need to sometimes save their lives.”
Anthem Blue Cross Blue Shield said Thursday that the health insurance provider is reversing a policy that was set to go into effect in February of that would have limited anesthesia coverage during surgeries and other procedures, a change that had prompted an outcry from some physicians and lawmakers. The policy, which would have covered Anthem's plans in Connecticut, New York and Missouri, was disclosed in recent weeks, with the company's New York unit posting a notice on Dec. 1. The policy would have excluded people under 22 years old and maternity care. According to the original policy statement, Anthem had said it would pay only for anesthesia treatments for the length of time that a procedure or surgery is estimated to require based on CMS's physician work time values. The insurer noted that claims for anesthesia "above the established number of minutes will be denied." Anthem said it was backing away from the policy, and added there had been "widespread misinformation about an update to our anesthesia policy."
UnitedHealthcare, whose chief executive Brian Thompson was gunned down in Manhattan Wednesday, has come under scrutiny for its high rate of claim denials in recent years. While the motive for the shooting remains under investigation, NYPD officials say the attack was "targeted" and "premeditated." The Associated Press reported that law enforcement found messages on the ammunition the gunman used — "deny," "defend," and "depose" — which may be referring to tactics the insurance industry uses to avoid paying claims. The company dismissed about one in every three claims in 2023 — the most of any major insurer. That's twice the industry average of 16%, according to data from ValuePenguin, a consumer research site owned by LendingTree that specializes in insurance. The group's analysis is based on in-network claims data from CMS.
The shocking, targeted killing of UnitedHealthcare CEO Brian Thompson Wednesday struck a nerve on social media, triggering an outpouring of negative experiences with the tangled healthcare system in the U.S. Many people shared searing stories of healthcare denials from health insurers. One person said his mom's scan to check on her stage IV lung cancer was recently denied. In another post, a dad shared the letter UHC sent him denying a wheelchair for his son with cerebral palsy.
With the GOP in control of Congress and the White House, hospitals could face budget cuts and tighter oversight, after a period of benefiting from generous federal spending under President Biden. Much of it comes down to hospitals' reliance on government insurance programs like ACA exchanges and Medicaid that could be cut down to size by Republicans looking for ways to trim government spending and pay for tax cuts. Medicaid expansions, boosted subsidies for ACA plans and programs like state directed payments—which funnel Medicaid dollars to hospitals—poured billions into the system, benefiting insurers and providers serving these programs. States and the federal government typically pay insurers, who then pay providers like hospitals. In recent years, due to changes in regulations, states have been able to tap additional federal dollars to steer more payments directly to providers. Just in October, analysts at TD Cowen upgraded hospital stocks, citing an expansion of state directed payments in several states.
