The Pharmacy Benefit Manger (PBM) industry, which is a critical player in transactions that facilitate the pricing and reimbursement of prescription drugs, has experienced a high level of vertical integration and aggregation of market power. Rujul Desai, Partner, Covington & Burling LLP, and Kendra Roberson, Partner, Faegre Drinker Biddle & Reath LLP, discuss the rise of PBMs and their role in drug pricing and the increasing scrutiny of the industry at the federal and state levels. Ru...

The Evolving Landscape of the PBM Industry

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Christopher P. Kenny, Partner, King & Spalding LLP, and Christina A. Hughes, Counsel, Powers Pyles Sutter & Verville PC, discuss some of the key issues related to provider-based status. They cover challenges related to the public awareness, notice of co-insurance, and distance requirements; and the difference between billing something as “provider-based” versus "under arrangement." Christopher and Christina spoke about this topic at AHLA’s 2024 Institute on Medicare and Medicaid Payme...

Provider-Based Status: Benefits and Challenges

Omenka Nwachukwu, Principal Consultant, Clearwater, speaks with Robert Kantrowitz, Partner, Kirkland & Ellis, about the key issues surrounding health care data privacy and the various points of intersection from a regulatory standpoint. They discuss challenges related to inferential data and de-identified data, federal and state privacy laws, the recently proposed American Privacy Rights Act and its implications for the health care sector, risks for health care organizations that share an...

The Patchwork That Is U.S. Health Care Data Privacy

Joe Wolfe, Attorney, Hall Render Killian Heath & Lyman PC, speaks with Charles Oppenheim, Partner, Hooper Lundy & Bookman PC, about trends, updates, reforms, and developments related to the Stark Law. They discuss the history of Stark and recent reforms, how both new and experienced lawyers can approach Stark, practical applications of the 2021 changes, and best practices for analyzing financial arrangements and creating compliance processes. Charles is the author of the supplement to...

Latest Stark Law Trends and Developments

Rob Gerberry, Senior Vice President and Chief Legal Officer, Summa Health, speaks with Michael Peregrine, Partner, McDermott Will & Emery, about how health care corporate boards can effectively exercise oversight of the corporate legal function. They discuss the general counsel’s dual reporting relationship, the history of the corporate responsibility movement, effective monitoring practices, and the significance of the recent Association of Corporate Counsel survey of general counsel.To ...

Health Care Corporate Governance: Board’s Oversight of the Corporate Legal Function

John Howlett, Senior Vice President and Chief Marketing Officer, Clearwater, speaks with Carolyn V. Metnick, Partner, Sheppard Mullin Richter & Hampton LLP, and Vanessa K. Burrows, Partner, Simpson Thacher & Bartlett LLP, about the current regulatory and legal landscape of artificial intelligence (AI) in health care. They discuss some of the most compelling ways health care organizations are using AI; the legal, ethical, privacy, and data security considerations around AI; enforcement...

The Evolving Landscape of the PBM Industry

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