Antitrust enforcers step up scrutiny of MFN clauses; insurers and health care providers should understand the competitive effects of 'most favored nation' pricing

Article Abstract:

Most favored nation (MFN) clauses are popular pricing vehicles of health insurers and medical providers, but these parties should carefully consider the possible anti-competitive effects of including such clauses in their contracts. Antitrust enforcers are paying close attention to MFN clauses in contracts, and red flags include coverage of a high percentage of patients in a particular geographic area, whether an MFN clause has the intended effect of lowering the fees paid to health care providers for services performed on covered patients, and whether an MFN clause is imposed by an organization itself controlled by health care providers.

Pharmaceutical industry, Finance, Prices and rates

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Health plan medical directors face greater scrutiny; increased role in establishing policies that implicate coverage decisions could lead to liability

Article Abstract:

Issues are discussed regarding the large number of managed care liability claims and the need for additional training for health plan medical directors these present. These directors may also find themselves implicated in HMO fiduciary liability claims based on the financial incentives involved.

Management, Managed care plans (Medical care)

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Discount health plans: all the rage? As alternative medicine becomes more popular, service providers jump on the bandwagon, although regulators are wary

Article Abstract:

The growth of discount health care service plans caused by increasing consumer demand for access to complementary and alternative medical treatment and economic factors such as declining insurance profit margins is discussed. Legislatures are starting to regulate discount plans.

Innovations

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