Policy/legal question

Type 1 & LADA
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They say that we might not have an FTC ruling until summer.

It’s not exactly helping The Dragons of healthcare when the establishment drags their feet because the states are gonna start suing for monetary damages. They are already filing en masse.

Only two states (MN & CA) had previously filed lawsuits over this and only one has settled - AG Ellison in MN (Swanson filed it before leaving office).

The FTC case was filed in administrative court - to enable a fast ruling, with no potential for monetary damages. Now states pickup their pitchforks. If we have to wait this long for an FTC ruling, then maybe we should be paid monetary damages for our trouble. MN already sued and settled with the insulin manufacturers, but not the PBMs.

Here’s the list:

AI forgot CA. CA also filed against the drug manufacturers and PBMs. Oregon wants 900 million dollars. That’s a big lawsuit. https://www.doj.state.or.us/media-home/news-media-releases/ag-rayfield-files-lawsuit-seeking-900-million-over-skyrocketing-insulin-prices/ But these suits can take 5 years to conclude. California filed early and they are 3 years into it. Indiana also filed.

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QUESTION:

Can you explain anything about ‘order of operations’ here? Like, if we expect an FTC ruling over the summer, how does that impact state lawsuits? In particular, if an FTC ruling results in no monetary damages, can the states still sue for monetary damages? Those state cases take 5 years to settle. So, we will get an FTC ruling first. How does FTC’s ruling cascade down through the chain of litigation? It’s not exactly the same a ruling in a traditional court. But I imagine it provides support for state actions? Maybe FTC doesn’t produce monetary damages directly, but has the power to influence that indirectly.

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Because Minneapolis is asking about detention scenarios
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Do you have a link for that? Your two links are to 2024 and 2025, I don’t see where the other references come from. There has been a change of administration since the original FTC lawsuit was filed.

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Sorry, I thought I included that. Let me find it. It’s here: Trump v. Slaughter and the Potential Impact on Agency Independence (US) | Employment Law Worldview (see last paragraph)

“Although a decision is not expected until this summer, employers, employees, and practitioners should monitor Trump v. Slaughter closely to understand the potential impacts on agency independence.“

Additional info: The Court Hears Arguments in Trump v. Slaughter: The End of Humphrey’s Executor? | Cranfill Sumner LLP - JDSupra .

So, FTC can rule really fast. They know how they will rule. But, we have to wait for Trump v Slaughter to resolve and I thought that would go fast. The Supreme Court can rule quickly (like, within a month) if they want to. But, apparently they are not going to be fast.

That always happens. Nothing gets thru the meat grinder in less than 4 years. That’s how the government is. It’s kinda designed to be that way - slow as f. Policy has to be resilient enough to have support from both parties. This does because its been bounced around for 20 years. It’s been vetted by everyone from the States all the way up to the Executive branch.

It might be worth addressing this a little more because the perception of the influence of partisan politics can be a little inflated, and it’s at it’s peak right now. Let me find you something SUPER recent. This was published yesterday (there were previous EOs about this matter).

“The Great Healthcare Plan will end the kickbacks paid by pharmacy benefit managers (PBMs) to the large brokerage middlemen that deceptively raise the cost of health insurance.” (See paragraph/bullet 8)

One way that you can see how bipartisan it is, is with state action. States have diverse party affiliations. State and Territory Attorneys General Call on Congress to Prohibit Pharmacy Benefit Managers from Owning or Operating Pharmacies - National Association of Attorneys General In addition to this, they are all suing/starting to sue en masse. That’s where it gets kinda interesting (to me). Why? I had totally given up on states being able to handle biz (I live in the first state to sue - c. 2018). Those cases take 5 years to conclude in a settlement. There’s just so many state resources that get burned up in the process and I don’t really believe that the states HAVE enough resources to sustain these suits over a long period of time. If EVERY state needs to sue over EVERY medication, that just strikes me as insane when the feds could come in and take care of biz. The states ARE asking for that (which is kinda unusual - typically states don’t want the feds interfering).

But what’s different between state (lawsuits) and federal (regulatory action) is monetary damages. That’s interesting. The states are asking for monetary damages. The feds don’t get that through regulatory action.

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Checkmate, @jbowler . We have them pinned down for sure now. The diabetics are gonna win. My one overarching complaint is that this took ten times longer than it could have. That is killing me. But all we need to do is walk it over the finish line now in a way that ensures we need to ask as little of congress as possible. Summer 2026 this is finalized…as far as I’m concerned.

What are my terms to conclude this 18 year battle?

I need rebates & spread pricing handled upfront.

I need to see the insurer “pay” for what they have done to us. What’s the minimum I require there to strike a deal on this? I’ve asked the pharmacists but I haven’t asked the diabetics.

I require the pharmacy arm be broken off CVS.

I really want the doctors freed from being beholden to a standard of care dictated by the insurers. But I’m not sure how to enforce that other than to say the insurers can’t employ physicians.

I’d like kickbacks in medicine to be formalized as illegal, in writing, by Congress.

What are our terms for me to stop raining down hell?

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