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Expert Analysis

NY Managed Care Organizations Flex Muscle Under ACA

Law360, New York (January 21, 2014, 6:54 PM EST) -- Managed care organizations ("MCOs") such as health care plans are assuming more control and influence over health care determinations for patients under the Affordable Care Act. In the pharmacy arena, however, their multiple roles as payer, provider and gatekeeper of information can create conflicts of interest that lead to aggressive tactics in dealing with doctors and patients that can violate New York's intricate pro-patient choice regulatory scheme. Those dealing with MCOs — and the pharmacy benefit managers ("PBMs") they hire as their agents — should be aware of statutory provisions to protect the rights of medical providers and patients....

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