ZorroCard Round Up

Hey all,

take a break from election news and read about healthcare payments Enjoy!

Jacob Brody (Co-Founder & CEO, ZorroCard)

The Curious Persistence of Site-Dependent Payments (JAMA)

This article critiques the persistence of “site-dependent” healthcare payments—higher charges for the same service in a hospital versus other settings—highlighting failed cost-saving efforts in the face of entrenched practices. Despite bipartisan support in the House for the Lower Costs, More Transparency bill aimed at Medicare payment reform, lobbying by hospitals stymies Senate progress, while private insurers also maintain these payment models. Employers’ failure to leverage purchasing power exacerbates costs, suggesting a need for new regulatory pressures, potentially through ERISA, to mandate employer diligence in healthcare spending. Full Article.

Transparency Shocker: Biosimilars Are Getting Cheaper—But Hospitals and Insurers Can Make Them Expensive (Drug Channels)

A recent analysis using Turquoise Health data reveals that hospitals and insurers often charge commercial plans far above acquisition costs for biosimilars, sometimes making them more expensive than their brand-name counterparts. This markup practice, driven by inflated hospital charges, results in insurers paying wildly different prices across hospitals, undermining cost-saving potential. Despite transparency regulations, these findings highlight how hospitals’ dominant pricing tactics increase overall healthcare costs. Full Article.

Lilly Joins Sanofi’s Legal Fight Over 340B Program Transparency (Cost Curve)

Eli Lilly has joined Sanofi in a legal push for transparency in the 340B drug discount program, seeking clarity on how contract pharmacies interact with covered entities, as the Health Resources and Services Administration (HRSA) has withheld critical contract information under FOIA requests. This case highlights ongoing industry frustrations with HRSA’s opaque handling of 340B oversight, especially as HRSA has historically defended providers over drugmakers, creating resistance to reform. The legal action underscores a broader call for 340B program accountability and reform. Full Article.: Eli Lilly has joined Sanofi in a legal push for transparency in the 340B drug discount program, seeking clarity on how contract pharmacies interact with covered entities, as the Health Resources and Services Administration (HRSA) has withheld critical contract information under FOIA requests. This case highlights ongoing industry frustrations with HRSA’s opaque handling of 340B oversight, especially as HRSA has historically defended providers over drugmakers, creating resistance to reform. Full Article.