The suit alleges that Indivior violated antitrust laws to preserve its Suboxone monopoly.
A federal judge in Philadelphia has ruled that 42 states may go forward with their antitrust “product hopping” lawsuit against Indivior Inc., the maker of the addiction treatment drug Suboxone.
The class-action suit, led by Wisconsin Attorney General Josh Kaul, alleges that Indivior in 2010 switched from a tablet to an under-the-tongue film strip while simultaneously attempting to "destroy" the market for tablets to preserve its drug monopoly.
"The cost of critical medication must not be inflated through anticompetitive tactics," Kaul said in a media release. "I'm proud that Wisconsin DOJ is leading this multistate litigation and thank AAG Cooley for her tireless efforts to hold the makers of Suboxone accountable."
In an 86-page ruling, the U.S. District Court Mitchell Goldberg denied Indivior's motion to toss the suit, saying the complaint against the drug maker was backed by sufficient facts and favorable law.
The multistate coalition filed a lawsuit in 2016, claiming that Indivior's tactics were anticompetitive and designed only to maintain Indivior's monopoly, a scheme known as a "product hop," which the states claim violates state and federal antitrust laws.
Indivior has claimed the switch was done to address safety concerns.
She succeeds Nadine Brooks Harris, MD, the state's first surgeon general.
Veteran public health expert Diana Ramos, MD, has been appointed California's new surgeon general by Gov. Gavin Newsom.
Ramos, 55, of Laguna Beach, described by the governor's office as "registered without party preference," is director of state public health and prevention programs at the California Department of Public Health's Center for Healthy Communities, a position she has held since 2021. Before that, she spent four years as CDPH's public health medical officer.
She succeeds Nadine Brooks Harris, MD, the state's first surgeon general, a post that pays $216,420 a year.
Ramos says she is "humbled and honored" by the appointment, and thanked Newsom "for this once-in-a-lifetime opportunity."
"And while this has certainly been a challenging time for all of us, I view this as an opportunity to do the good work California has become known to do. To do the good work this office has been known to do."
Newsom created the surgeon general's office in 2019 on his first day in office, reasoning that the state needed a leadership voice on public health issues.
"Dr. Ramos is a distinguished leader in medicine and a trusted public health expert who brings a lifetime of experience protecting and promoting the health of vulnerable communities," Newsom says. "I look forward to her partnership in advancing urgent priorities for the state on women's health, mental health, addressing the gun violence epidemic, and more as we continue our work to lift up the health and well-being of all Californians."
Ramos' resume also includes stints as an adjunct assistant clinical professor at the University of Southern California Keck School of Medicine – where she also earned her medical degree -- since 1999, and a per diem physician at Kaiser Permanente since 1998.
Ramos is also the founder and one-time CEO of Gami-Fi Health since 2018, and the former director of reproductive health at the Los Angeles County Department of Public Health's Maternal, Child and Adolescent Health Division from 2005 to 2017.
She was CMO at Alpha Medical Center Inc. from 2003 to 2005. She was a Senior Regional Medical Research Specialist at Pfizer Inc. from 2000 to 2003 and a Staff Obstetrician at Clinica Humanitaria from 1999 to 2000.
The California Nurses Association railed against the "backroom deal."
Just days after the collapse of an alleged backroom deal with hospitals to swap relaxed seismic standards for higher wages, a California healthcare workers' union opened its push to enact a statewide $25 healthcare minimum wage.
More than 200 members of the Service Employees International Union – Union of Healthcare Workers West will meet with state lawmakers to press for the statewide wage hike that has already been enacted in four Southern California cities.
"Through the process of passing local ordinances and talking to elected officials about statewide legislation, we've discovered an enormous appreciation for healthcare workers among lawmakers and the public and an understanding of how low wages are making the healthcare staffing crisis worse," says Dave Regan, SEIU-UHW president.
"There is a broad understanding that it was frontline healthcare workers, not greedy hospital executives, who put their lives on the line and continue to carry California through the COVID crisis. We are calling on every city in the state to pass a local ordinance establishing a $25 minimum wage immediately. We are calling on the legislature and, if necessary, the state's voters to establish a $25 minimum wage within the year."
In a media release, the union claimed that the California Hospital Association "walked away from a conceptual agreement that would have broadly established a healthcare worker minimum wage of up to $25 and update the timeline and scope for seismic upgrades to hospitals."
"The hospital industry demanded a loophole that would have allowed hospitals to evade the new minimum wage by outsourcing or moving work to other facilities. The hospital industry also refused to commit to using properly trained construction workers to ensure safety in seismic upgrades of their facilities," the union says.
The Los Angeles Times, citing an internal CHA memo, said the deal "came together quickly and followed years of stymied attempts to delay a state law that requires hospital buildings to have earthquake upgrades by 2030," which would cost about $100 billion and force closures across the state.
CNA President Sandy Reding, RN, railed against the deal, saying "it is unconscionable that any union would demand handouts from our elected leaders to support a gift to the hospital industry instead of prioritizing the lives, protection, and safety of patients, hospital workers, and our communities."
"We call on California officials to reject this appalling proposed backroom deal that could endanger countless lives and access to essential care for many others across our state from the next major earthquake that is sure to come," Reding says.
Insurers deny allegations, say plans are already under rigorous oversight.
Senate Finance Committee Chair Ron Wyden, D-OR, is asking insurance regulators in 15 states to send him consumer complaints about Medicare plans using “potentially deceptive” marketing to sell coverage.
"I have heard alarming reports that MA and Part D health plans and their contractors are engaging in aggressive sales practices that take advantage of vulnerable seniors and people with disabilities," Wyden says in his letter to the regulators.
"I write seeking information about potentially deceptive marketing practices being conducted by insurance organizations offering Medicare benefits under the Medicare Advantage (MA) program and the Part D prescription drug program," he says.
Wyden notes that the Centers for Medicare & Medicaid Services got more than twice the numbers of complaints about Medicare Advantage plans in 2021 than it did in 2020.
The letters were sent to regulators in Arizona, California, Colorado, Florida, Georgia, Illinois, Massachusetts, Michigan, Missouri, New York, North Carolina, Ohio, Oregon, Pennsylvania, and Texas.
Health Plans Respond
The Better Medicare Alliance, a trade group financed by the nation's largest health insurance companies, took issue with Wyden's letter.
BMA President and CEO Mary Beth Donahue, said in a media release that "Medicare Advantage plans' marketing materials are already subject to careful regulation: they must be approved by CMS and are answerable to more than 50 pages of federal guidelines."
"With a 94% consumer satisfaction rate, it is clear that this program consistently lives up to its promise for seniors," Donahue says, citing a BMA-commissioned survey released in January.
Instead of overregulating health plans, Donahue says "policymakers must take action to modernize Medicare enrollment in ways that offer more transparency in coverage choices and empower consumers, rather than criticizing those standing in the gap to help beneficiaries navigate this difficult and complicated process."
Kaiser has about 50 mental health clinicians to provide care for the HMO’s 266,000 members in Hawaii. Their open-ended walkout starts on Aug. 29.
Kaiser Permanente mental health workers in Hawaii will soon join their California counterparts on picket lines to protest what they say is woeful understaffing for mental health services.
"Kaiser's business model is to starve its behavioral health services and short-change patients who can go months without care," says Sal Rosselli, president of the National Union of Healthcare Workers, which represents Kaiser mental health clinicians in California and Hawaii.
"Through strike activity our members are using their power to make Kaiser stop treating mental healthcare as a second-class service and start providing care that its paying customers are legally entitled to receive," Rosselli says.
Kaiser has about 50 mental health clinicians to provide care for the HMO's 266,000 members in Hawaii, according to the NUHW. The Hawaii clinicians held a three-day strike in May, and this latest walkout starts on Aug. 29 and will be open-ended, the union says.
Kaiser's accreditation in Hawaii is under "corrective action" with the National Committee for Quality Assurance after the clinicians filed a complaint documenting what clinicians say are dangerously long waits times for mental health appointments.
NCQA determined that the "lack of access to (behavioral health care) for Kaiser members poses a potential patient safety risk" and that "Kaiser's prior efforts to improve access… have largely been ineffective."
More than 2,000 Kaiser mental health clinicians in Northern California walked off the job on Aug. 15 to protest the HMO's chronic understaffing, which the NUHW says is continuing despite Kaiser having $54 billion in reserves. The striking clinicians are actively picketing Kaiser hospitals across Northern California.
Kaiser spokeswoman Deb Catsavas has called the walkout "perplexing" and the union’s tactics "unethical and counterproductive."
"In our last bargaining session we were about 1% apart in our respective wage proposals, and we came to bargaining … with hopes to bargain vigorously and bring negotiations to a conclusion," Catsavas said after the Aug. 15 walkout. "Unfortunately, union leadership delivered a fully new economic proposal from NUHW that avoids reaching agreement and pushes us further apart."
The settlements involve Gold Coast Health Plan, and Medi-Cal providers Dignity Health, Clinicas del Camino Real, Inc.
Ventura County and three healthcare organizations will pay California and the federal government $70.7 million to resolve whistleblower allegations of an "organized scheme" to bilk Medi-Care, state and federal prosecutors have announced.
Along with Ventura County -- the owners of Ventura County Medical Center – the three settlements include Gold Coast Health Plan, and Medi-Cal providers Dignity Health, Clinicas del Camino Real, Inc.
Prosecutors allege the providers "submitted false claims in an organized scheme to illegally keep federal funds intended for Medicaid Adult Expansion under the Affordable Care Act. California will get $2.45 million of the settlement, plus accrued interest."
"Medi-Cal props up our communities by providing access to free or affordable healthcare services for millions of Californians and their families,” California Attorney General Rob Bonta says in a media release. "Those who attempt to cheat the system are cheating our communities of essential care."
Starting in 2014, Medi-Cal expanded to cover uninsured adults without dependent children with annual incomes up to 133% of the federal poverty level. The feds, who fully funded the expansion for its first three years, intentionally overfunded to provide a cushion to cover additional medical needs for the newly insured population.
Gold Coast's contract with the state stipulated that if it did not spend at least 85% of what it received for the AE population on eligible services, the surplus money would be returned to Medi-Cal, which would return that money the federal government.
Ventura County will pay the federal government $29 million, Gold Coast will pay $17.2 million, Dignity will pay $10.8 million to the federal government and $1.2 million California, and Clinicas will pay $11.25 million to the feds and $1.25 million to the state.
The settlements are the results of a whistleblower lawsuit filed by Atul Maithel, Gold Coast's former controller, and Andre Galvan, Gold Coast's former director of member services.
Dignity Health Denies Allegations
Dignity Health issued a statement saying it "denies all of the allegations and resolves the matter expressly without conceding any liability."
"During the period January 1, 2014 through May 31, 2015, Dignity Health d/b/a St. John’s Regional Medical Center and St. John's Pleasant Valley Hospital provided critically necessary population health management and related services to this newly-eligible adult Medi-Cal population in Ventura County. The hospitals provided these services in addition to the underlying services agreement between the hospitals and Gold Coast Health Plan, the county organized health system responsible for administering the Medi-Cal program in Ventura County, and received fair market value compensation for the services actually provided to this vulnerable population.
"Dignity Health denies all of the allegations and resolves the matter expressly without conceding any liability. Dignity Health continues to maintain that all the reimbursement received was properly utilized in serving Ventura County's Medi-Cal beneficiaries. Consistent with their mission, these hospitals continue to both serve the Medi-Cal population in Ventura County and innovate in the areas of prevention, education, and case management services."
Crozer will revert to a nonprofit, the status it held before 2016 when it was acquired by Los Angeles-based, for-profit Prospect Medical Holdings.
ChristianaCare Health System, Inc., and Pennsylvania-based for-profit Crozer Health have called off merger talks, blaming the changing “economic landscape,” over the past six months, the two health systems announced jointly on Thursday.
Had the deal been completed, it would have given ChristianaCare a toehold in the competitive Southeastern Pennsylvania market that includes Penn Medicine, Jefferson Health, and Main Line Health.
No specific reason was given for stopping the negotiations, which began in February with the signing of a letter of intent, but the press release issued by both health systems noted that "since the signing of the LOI in February, the economic landscape has significantly changed, impacting the ability of the sale to move forward."
"Both organizations worked very hard to reach a final agreement and have significant respect for each other and remain committed to caring for the health of those in Delaware County," the statement read.
In a letter to Crozer Health employees, cited by The Inquirer, leadership at the Springfield, PA-based health system and parent Prospect said the reversion to nonprofit status will "allow us to engage with the community through local governance, support from community-based volunteers, and the creation of partnerships with community-based organizations."
The letter said that Crozer will reopen its Springfield Hospital "as a comprehensive outpatient complex with an Emergency Department, medical offices, ancillary services, and ambulatory surgery center," and that 60% of Crozer’s revenue already comes from outpatient services, according to The Inquirer.
Wilmington-based ChristianaCare, Delaware's largest health system, includes three hospitals with a combined 1,300 licensed beds, a freestanding emergency department, and a network of physician offices and outpatient clinics.
Prospect owns 17 hospitals and more than 165 clinics and outpatient centers in California, Connecticut, Pennsylvania, Rhode Island, and Texas.
Crozer Health, formed in 1990 by the merger of Crozer-Chester Medical Center in Upland, Pa. and Delaware County Memorial Hospital in Drexel Hill, Pa, includes Taylor Hospital in Ridley Park, and Springfield Hospital in Springfield.
Plans that spend more for primary care are more likely to get better ratings from NCQA.
A first-of-its-kind study involving 5.4 million Medi-Cal managed care enrollees -- nearly half of the state’s Medicaid plan members – links higher spending for primary care with better care quality, patient experience, and plan ratings.
"Increasing emphasis on primary care in Medi-Cal is essential to improving health and well-being and reducing health disparities," says Kathryn E. Phillips, senior program officer at the California Health Care Foundation, which commissioned the study. "This study provides an important baseline for understanding how greater investment in primary care can improve performance."
The study by Edrington Health Consulting found that plans that spent more for primary care were more likely to get a better rating from the National Committee for Quality Assurance. The study examined 13 Medi-Cal managed care plans and found wide variation in primary care spending, from $8.85 to $61.24 per member per month, or roughly 11% of healthcare dollars spent on primary care, with a range from 5% to 19%.
When specific quality metrics were studied, plans with a higher percentage of spending on primary care performed better on nine of 11 measures. Three of these measures met criteria for statistical significance and align with state priorities: receipt of recommended cancer screenings and two measures of management of medications for depression.
The findings come just weeks after California established a new Office of Health Care Affordability to measure and promote a greater role for primary care in the state's healthcare delivery system.
Beginning in 2024, the California Department of Health Care Services will require all Medi-Cal managed care plans to report on primary care expenditures for the plan's more than 10.8 million enrollees.
"DHCS is committed to reducing the stark racial and ethnic disparities in access to primary care. These include maternity outcomes and children's preventive services, as well as improving maternal and adolescent depression screenings," says Palav Babaria, MD, CQO CDHCS. "This study will serve as a benchmark among Medi-Cal managed care plans as we seek to achieve these and other bold goals."
Federal watchdogs have raised concerns after the recent deaths of nine patients who were discharged or transferred to other facilities.
The City of San Francisco and patients' advocates have filed a pair of lawsuits aimed at reversing the federal government’s decision to cut funding and order discharges or transfers by Sept. 13 for all patients at the troubled Laguna Honda Hospital & Rehabilitation Center.
"The federal government has put Laguna Honda and our City in an impossible situation," City Attorney David Chiu says in a media release. "As the final safety net for many of our most vulnerable San Franciscans, Laguna Honda serves too critical a need to be closed due to an arbitrary, bureaucratic decision."
The 156-year-old skilled nursing facility cares for nearly 700 patients and relies on more than $200 million in funding each year from the federal government. However, federal watchdogs have raised concerns after the recent deaths of nine patients who were discharged or transferred to other facilities.
The city’s lawsuit against the U.S. Department of Health and Human Services and Secretary Xavier Becerra alleges that the Centers for Medicare & Medicaid Services forced the city to implement an unworkable closure and transfer plan that denies the city due process and puts Laguna Honda patients at risk.
The complaint claims CMS imposed an arbitrary Sept. 13 deadline to transfer Laguna Honda's patients and has denied the city due process as the facility is required to close well before the city's administrative appeals can be decided—appeals that would render the transfers unnecessary.
The lawsuit asks a federal judge to eliminate the Sept. 13 deadline and extend federal funding to Laguna Honda at least until the appeals can be decided and all patients can be safely transferred or discharged.
A separate class-action lawsuit filed on behalf of Laguna Honda patients and families, alleges that the closure of Laguna Honda and rushed transfer process violate the Americans with Disabilities Act and deny patients and their families substantive and procedural due process.
"For over 150 years, San Franciscans have relied on Laguna Honda to provide critical care to our most vulnerable," says plaintiffs counsel Louise Renne, a former city attorney and now a partner at Renne Public Law Group.
"We simply cannot allow Laguna Honda to close. The actions of CMS and the California Department of Health are illegal, unnecessary, and cruel."
Chiu says CMS's mandate forces San Francisco "into an unworkable closure and transfer plan that has done far more harm than good. Hundreds of patients' lives are stake. We are taking legal action today in the hope that a court will compel the federal government to exercise compassion and common sense."
San Francisco Mayor London N. Breed says the city is "working hard to address issues that have been raised at Laguna Honda, and that important work will continue."
"But closing this facility and forcing residents and families to go through the trauma of transfers should not be part of that process," Breed says.
"This facility provides care and support for some of the most vulnerable people in our city, and that support must continue to keep them healthy and safe."
Both suits are filed with the U.S. District Court for the Northern District of California.
Unionized clinicians in Northern California plan to start picket lines and rallies outside Kaiser facilities throughout the Bay Area and from Sacramento to Fresno.
More than 2,000 Kaiser Permanente mental health clinicians – claiming burnout and frustration from alleged chronic understaffing – are poised to begin an open-ended strike starting on August 15.
"We're serving a strike notice because our patients aren't receiving needed services." Shay Loftus, a psychologist in Kaiser's Napa/Solano region, says in a news release issued by the National Union of Healthcare Workers. "We're not willing to be part of a system that disrespects the work we do and prevents us from providing ethical care. Kaiser has no excuse to continue treating mental healthcare as a separate and unequal service, and we're going to keep striking until that changes," Loftus says.
Unionized psychologists, therapists, chemical dependency counselors and social workers in Northern California plan to start picket lines and rallies outside Kaiser facilities throughout the Bay Area and from Sacramento to Fresno.
Money is not the issue, the union says, noting that KP reported an $8.1 billion net profit last year, and they system’s HMO has $54 billion in reserves. The disgruntled clinicians say that in Northern California, Kaiser staffs one fulltime equivalent mental health clinician for every 2,600 members, forcing patients to wait months to begin therapy regimens. As a result of delayed care and a relentless caseload, the union says therapists are leaving Kaiser at a record rate.
Kaiser has been fined by state regulators for its lack of mental healthcare, sued by local prosecutors and is now facing a new state investigation following a sharp rise in patient complaints last year. Kaiser also has failed to comply with a new state law requiring follow-up mental health therapy appointments be provided within 10 business days, the union claims.
NUHW President Sal Rosselli says most of the nation's mental health clinicians are not unionized, which he says is one reason why mental healthcare has not attained parity in services.
"Patients are getting ripped off while Kaiser's coffers are bulging," Rosselli says. "We don't take striking lightly but it's time to take a stand and make Kaiser spend some of its billions on mental healthcare."
After more than one year of negotiations, Rosselli says KP has rejected staffing increases and improved access to care, prompting clinicians in June to authorize their first ever open-ended strike.
'Unethical and Counterproductive'
With the walk out looming, Deb Catsavas, senior vice president of human resources at KP, says the health system is "still in active bargaining and are committed to resolving the issues and reaching an agreement."
"It is perplexing that NUHW leaders have chosen to strike when we were close to an agreement," Catsavas says. "In our last bargaining session we were about 1% apart in our respective wage proposals, and we came to bargaining last Friday with hopes to bargain vigorously and bring negotiations to a conclusion. Unfortunately, union leadership delivered a fully new economic proposal from NUHW that avoids reaching agreement and pushes us further apart."
"Despite the unethical and counterproductive tactics by NUHW's leadership, we are committed to bargaining in good faith to reach a fair and equitable agreement that is good for our therapists and our patients," Catsavas says.
