Multiplan Suit Proceeds, Deadly PBM Formulary, & Regeneron Reduces Muscle Loss

Hey all,

Happy Thursday! Another day, another lawsuit alleging carrier malfeasance. Multiplan’s business model was to collaborate with multiple plans (get it, Multiplan) to lower reimbursement rates. So many businesses in healthcare are based around extracting value from providers and patients, pushing it back to big plans and PE firms. Enjoy the rundown! 

Jacob Brody (Co-Founder & CEO, ZorroRX)

(Fierce Healthcare) Judge Allows Antitrust Case Against MultiPlan to Proceed 

A federal judge has denied motions to dismiss key antitrust and consumer protection claims against MultiPlan (now Claritev) and several major insurers, allowing healthcare providers’ lawsuits alleging price-fixing and underpayment for out-of-network services to move forward. The plaintiffs, including the American Medical Association, argue that Claritev and insurers formed a “cartel” to suppress reimbursements, harming small practices and reducing patient access, while the defendants maintain their practices are legal and based on public data. The case now heads into discovery and could reshape how provider reimbursements are negotiated in the U.S. healthcare system—at this rate, the only thing insurers are missing is a group discount on RICO defense attorneys. Full Article

(HEALTH CARE un-covered) PBM Practices and the Death of Cole Schmidtknecht

A 22-year-old named Cole Schmidtknecht died after being unable to afford his asthma medication when Optum Rx, a major pharmacy benefit manager (PBM), dropped it from coverage without notice, causing the price to spike from $70 to over $500. His death underscores the dangerous opacity and profit-driven incentives of PBMs, which control most of the U.S. prescription drug market and often prioritize high-rebate drugs over patient access and affordability. As Cole’s parents sue Optum Rx and Walgreens, bipartisan momentum grows in Congress to rein in PBM abuses and bring transparency to a system many Americans don’t realize controls their medication costs. Full Article.

(Reuters) Regeneron’s Weight-Loss Drug Preserves Muscle 

Regeneron’s experimental drug trevogrumab preserved up to 51% more lean muscle mass when combined with Wegovy, compared to Wegovy alone, in a mid-stage trial involving 599 patients. As muscle loss is a key drawback of popular obesity drugs, this finding positions Regeneron competitively in a booming $150 billion market, though safety concerns and regulatory clarity remain crucial hurdles ahead of late-stage data. Regeneron joins a growing field of companies—including Eli Lilly, Scholar Rock, and Veru—developing next-generation weight-loss treatments that aim to preserve or enhance muscle mass alongside fat reduction. Full Article