Judges Love PBMs, 340B Discounts Go On Layaway, The Brain’s Side Hustle In Immunology

Hey all,

Happy Monday! The new 340B rebate program is expected to create significant financial strain for non-profit hospitals, as the shift from discounts to rebates will delay cash flow and reduce immediate savings. Individual covered entities I’ve spoken with are anticipating the program will reduce free cash flow by tens of millions of dollars on just a handful of high-cost drugs, creating budget gaps and cash flow issues. It remains to be seen how these changes will affect their ability to provide uncompensated care and community programs as these financial pressures hit later this year.

Enjoy the rundown! 

Jacob Brody (Co-Founder & CEO, ZorroRX)

(BenefitsPro) CVS, Cigna, UnitedHealth Win Arkansas PBM Court Battle

A federal judge has issued a preliminary injunction blocking an Arkansas law that bans pharmacy benefit managers (PBMs) like CVS, Cigna, and UnitedHealth from owning pharmacies, ruling that the law discriminates against out-of-state companies and violates the interstate commerce clause. The decision highlights a broader national debate over vertical integration in healthcare and states’ power to regulate PBMs, with implications for competition, drug pricing, and patient access to medications; Arkansas’ attorney general plans to appeal. And remember, someone has to stand up for the poor, oppressed, vertically integrated PBMs! Full Article.

(Modern Healthcare) HRSA 340B Rebate Pilot Program

The Health Resources and Services Administration (HRSA) announced a 2026 pilot program allowing drugmakers to issue post-purchase rebates instead of upfront discounts to safety-net providers under the 340B Drug Pricing Program. This change marks a significant shift from the program’s 30-year norm, sparking concerns from hospitals and provider groups about delayed savings and financial strain. But hey, since 340B is off budget, my money’s on this staying neatly fenced around IRA drugs for the foreseeable future. Full Article

(Ground Truths – Eric Topol) Brain-Immune Axis

New research reveals that the brain and immune system are tightly connected, with visual infection cues triggering immune activation, a vagus nerve stimulation implant gaining FDA approval for rheumatoid arthritis, and immune dysregulation linked to Alzheimer’s risk in APOE4 carriers. These discoveries highlight how the brain-immune axis influences autoimmune, neurodegenerative, and inflammatory diseases. They also open the door to new treatments that fine-tune immune responses for better health and longevity. Full Article.