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Step Therapy: Legal And Ethical Implications Of A Cost-Cutting Measure, Sharona Hoffman 2018 Case Western Reserve University School of Law

Step Therapy: Legal And Ethical Implications Of A Cost-Cutting Measure, Sharona Hoffman

Faculty Publications

The very high and ever-increasing costs of medical care in the United States are well-recognized and much discussed. Health insurers have employed a variety of strategies in an effort to control their expenditures, including one that is common but has received relatively little attention: step therapy. Step therapy programs require patients to try less expensive treatments and find them to be ineffective or otherwise problematic before the insurer will approve a more high-priced option. This Article is the first law journal piece dedicated to analyzing this important cost control measure.

The Article explores the strengths and weaknesses of step therapy ...


Access To Prescription Drugs: A Normative Economic Approach To Pharmacist Conscience Clause Legislation, Joanna K. Sax 2017 University of Maine School of Law

Access To Prescription Drugs: A Normative Economic Approach To Pharmacist Conscience Clause Legislation, Joanna K. Sax

Maine Law Review

Over the past several years, many states introduced legislation that protects a pharmacist’s decision to refuse to fill a prescription. Termed “conscience clauses,” these pieces of legislation allow a pharmacist to refuse to fill a prescription because of moral or religious objections without fear of legal repercussions. In 2006, for example, twenty-one states considered legislation that permits pharmacists to refuse to fill prescriptions; some bills focus on contraception alone, while others are not specific to any one type of medication. Arkansas, Mississippi, Georgia, Florida, and South Dakota have state laws that provide legal protection to pharmacists who refuse to ...


Catholicism, Ethics And Health Care Policy, Lisa Sowle Cahill 2017 St. John's University School of Law

Catholicism, Ethics And Health Care Policy, Lisa Sowle Cahill

The Catholic Lawyer

No abstract provided.


Tipping The Scales?: Maine Adopts The Continuing Negligent Treatment Doctrine In Baker V. Farrand, Michael P. Beers 2017 University of Maine School of Law

Tipping The Scales?: Maine Adopts The Continuing Negligent Treatment Doctrine In Baker V. Farrand, Michael P. Beers

Maine Law Review

In Baker v. Farrand, the Maine Supreme Judicial Court, sitting as the Law Court, held that for a series of related negligent acts or omissions committed by a health care provider or practitioner, a single cause of action “accrues” under the Maine Health Security Act (hereinafter MHSA) on the date of the last act or omission that contributed to the plaintiff’s injury. Hence, in situations where a physician provides continuing negligent treatment to a patient in which each and every one of the physician’s actions are negligent, the MHSA’s three-year statute of limitations does not begin to ...


Anthem Health Plans Of Maine, Inc. V. Superintendent Of Insurance: Judicial Restraint Or Judicial Abdication?, David E. Sorensen 2017 University of Maine School of Law

Anthem Health Plans Of Maine, Inc. V. Superintendent Of Insurance: Judicial Restraint Or Judicial Abdication?, David E. Sorensen

Maine Law Review

When Maine’s Superintendent of Insurance told the state’s largest health insurer that it could not profit in 2009, her decision ended up on appeal before the Maine Supreme Judicial Court, sitting as the Law Court, in Anthem Health Plans of Maine, Inc. v. Superintendent of Insurance. As part of its annual rate approval process, Anthem had requested a 3% profit and risk margin on its individual lines of health insurance in Maine. Superintendent Mila Kofman denied this request under her statutory authority to deny any rate increase proposals that are “excessive, inadequate or unfairly discriminatory.” The Superintendent held ...


Law & Health Care Newsletter, Fall 2017, 2017 University of Maryland Francis King Carey School of Law

Law & Health Care Newsletter, Fall 2017

Law & Health Care Newsletter

No abstract provided.


A Deliberate Departure: Making Physician-Assisted Suicide Comfortable For Vulnerable Patients, Browne C. Lewis 2017 Cleveland-Marshall College of Law, Cleveland State University

A Deliberate Departure: Making Physician-Assisted Suicide Comfortable For Vulnerable Patients, Browne C. Lewis

Browne C Lewis

This Article is divided into four parts. Part I discusses the history and evolution of the "right to die movement" in the United States. The current legal landscape in the United States is examined in Part II. In Part III, I analyze some of the relevant ethical concerns caused by the availability of physician-assisted suicide. My analysis primarily focuses on the Oregon statutes because it is the oldest physician-assisted suicide law in the United States and has served as a model for laws in the United States and abroad. For example, Lord Falconer's Bill, which was defeated by the ...


The Medicare Appeals Crisis: Why Mediation Is The Medicine, Michelle Ellis 2017 Pepperdine University

The Medicare Appeals Crisis: Why Mediation Is The Medicine, Michelle Ellis

Pepperdine Dispute Resolution Law Journal

This article will explore how unmeritorious RAC-reversals recently polluted the Medicare appeals process, and how this has led to a crisis for both providers and the United States Department of Health & Human Services (HHS). Furthermore, this article will consider the lack of available remedies and narrow measures taken by HHS, and will instead advocate for mediation as the best means of easing the backlog. While the delays also directly affect Medicare beneficiaries, this article will limit its discussion to the backlog in relation to providers and suppliers.


Open Source: The Enewsletter Of Rwu Law 09-22-2017, Roger Williams University School of Law 2017 Roger Williams University

Open Source: The Enewsletter Of Rwu Law 09-22-2017, Roger Williams University School Of Law

Life of the Law School (1993- )

No abstract provided.


Erisa And Graham-Cassidy: A Disaster In Waiting For Employee Health Benefits And For Dependents Under 26 On Their Parents’ Plans, Leslie Francis 2017 S.J. Quinney College of Law, University of Utah

Erisa And Graham-Cassidy: A Disaster In Waiting For Employee Health Benefits And For Dependents Under 26 On Their Parents’ Plans, Leslie Francis

Utah Law Faculty Scholarship

Graham Cassidy § 105 would repeal the ACA “employer mandate”. Although its sponsors claim that the bill will give states a great deal of flexibility, it will do nothing to help states ensure that employers provide their employees with decent health insurance; quite the reverse. It will also give employers the freedom to ignore the popular ACA requirement that allows children up to age 26 to receive coverage through their parent’ plans, at least when their parents get health insurance from their employers. Here’s why.


Health Information Technology, E-Prescribing And Hurricane Katrina: Could Electronic Health Records Have Made A Difference, Robert Malone 2017 University of Oklahoma College of Law

Health Information Technology, E-Prescribing And Hurricane Katrina: Could Electronic Health Records Have Made A Difference, Robert Malone

Oklahoma Journal of Law and Technology

No abstract provided.


Health Information Technology And Hipaa: Can We Satisfy Security And Privacy Standards In The Digital Age, Robert Malone 2017 University of Oklahoma College of Law

Health Information Technology And Hipaa: Can We Satisfy Security And Privacy Standards In The Digital Age, Robert Malone

Oklahoma Journal of Law and Technology

No abstract provided.


Health Information Technology: Transforming The Healthcare Industry For The 21st Century, Robert Malone 2017 University of Oklahoma College of Law

Health Information Technology: Transforming The Healthcare Industry For The 21st Century, Robert Malone

Oklahoma Journal of Law and Technology

No abstract provided.


How To Think About Religious Freedom In An Egalitarian Age, Nelson Tebbe 2017 Cornell Law School

How To Think About Religious Freedom In An Egalitarian Age, Nelson Tebbe

Nelson Tebbe

No abstract provided.


Racist Health Care: Reforming An Unjust Health Care System To Meet The Needs Of African-Americans, Vernellia R. Randall 2017 Selected Works

Racist Health Care: Reforming An Unjust Health Care System To Meet The Needs Of African-Americans, Vernellia R. Randall

Vernellia R. Randall

No abstract provided.


Managed Care, Utilization Review, And Financial Risk Shifting: Compensating Patients For Health Care Cost Containment Injuries, Vernellia R. Randall 2017 Selected Works

Managed Care, Utilization Review, And Financial Risk Shifting: Compensating Patients For Health Care Cost Containment Injuries, Vernellia R. Randall

Vernellia R. Randall

This Article examines current tort remedies for personal injury claims and explores the problems that arise when these remedies are applied to physicians' actions that are directed by third-party payers. Part II of this Article explores the organization and historical development of managed health care products. Part III considers the past and present uses of the utilization review process and financial risk shifting. Part IV explores the applicability of traditional theories of tort liability to third-party payers, including direct liability of third-party payers who market managed care products. Part V considers the barriers that ERISA presents to compensating patients for ...


Substance Use Disorder Treatment Confidentiality Boot Camp, Lucy C. Hodder, Stephanie Cameron, Marcy Doyle, Christina Muñiz, Jeanne Ryer 2017 University of New Hampshire School of Law

Substance Use Disorder Treatment Confidentiality Boot Camp, Lucy C. Hodder, Stephanie Cameron, Marcy Doyle, Christina Muñiz, Jeanne Ryer

Legal Scholarship

[Excerpt]: "INTRODUCTION: The Health Law and Policy Programs at UNH School of Law, Institute for Health Policy and Practice, and the NH Citizens Health Initiative have contracted with several of the New Hampshire Building Capacity for Transformation Delivery System Reform Incentive Payment (DSRIP) Integrated Delivery Networks (IDN) to provide technical assistance to the IDNs as they develop confidentiality tools related to substance use disorder services projects.

A UNH Team assisted the IDNs by providing an educational summary of federal and state confidentiality requirements, focusing on 42 CFR Part 2, and hosting IDN interdisciplinary teams in three Substance Use Disorder (SUD ...


The Aftermath Of Care V. Cow Palace And The Future Of Rcra In Cafo Cases, Lauren Tavar 2017 American University Washington College of Law

The Aftermath Of Care V. Cow Palace And The Future Of Rcra In Cafo Cases, Lauren Tavar

Sustainable Development Law & Policy

No abstract provided.


Water, Water, Nowhere: Adapting Water Rights For A Changing Climate, Caleb Hall 2017 American University Washington College of Law

Water, Water, Nowhere: Adapting Water Rights For A Changing Climate, Caleb Hall

Sustainable Development Law & Policy

No abstract provided.


Ridding Pes Systems Of The “Pay To Pollute” Principle: Pes Optimization Strategies, Kelly Carlson 2017 American University Washington College of Law

Ridding Pes Systems Of The “Pay To Pollute” Principle: Pes Optimization Strategies, Kelly Carlson

Sustainable Development Law & Policy

No abstract provided.


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