Anthem Ghosts Members, 340B Growth Drives Hospital Consolidation, Site Neutral Payments Beats Biosimilars

Hey all,

Happy Tuesday! Centene’s ghost network lawsuit is another example of the rot lying beneath the shiny veneer health insurance companies project. While there are some good actors, many have learned that opacity and obfuscation are the easiest ways to reliably profit in US healthcare. Enjoy the rundown! 

Jacob Brody (Co-Founder & CEO, ZorroRX)

(Oxford University Press) Drivers of 340B Growth

A new study finds that over 80% of the growth in the federal 340B Drug Pricing Program from 2018 to 2024 was driven by increased drug utilization rather than rising manufacturer prices. This challenges the common defense by 340B advocates that manufacturer price hikes are to blame for program expansion, instead highlighting strategic hospital behavior and increased usage as the main growth factors. These findings could shape future reforms aimed at ensuring the program better serves vulnerable populations—and really, as hospitals sank deeper underwater, why reinvent care or business models when ramping up 340B capture offered better margins with far less effort? Full Article

(Modern Healthcare) Centene Ghost Network Lawsuit
Centene Corp. has been sued for allegedly maintaining a "ghost network" by listing healthcare providers in its directories who are not actually in-network, accepting new patients, or even still practicing. The wrongful death lawsuit, filed in Arizona, claims the plaintiff’s son died after being unable to access mental health services that were falsely advertised as available by Centene’s subsidiary, Arizona Complete Health, intensifying industry concerns over deceptive network practices. Centene joins Anthem and its Carelon subsidiary in the ghost-network lawsuit party, once again proving that its easier to make up a mental health provider network than maintain one. Full Article

(Health Affairs) Site-Neutral Payment and Biosimilars Competition 

A new analysis reveals that site-neutral payment policies could generate twice the savings of biosimilars competition—$1.004 billion versus $0.465 billion—over three years for infused cancer biologics, based on claims data from over 43,000 patients. The findings underscore that while biosimilars reduce drug prices through market dynamics, aligning hospital and physician office reimbursement levels more directly addresses payment inefficiencies, and combining both strategies offers the greatest potential for reducing oncology drug spending. PBM reform isn’t the only way to cut drug costs—just follow the trail of private jets and seven-figure bonuses at your local health system. Full Article.