340B Case Continues, AHA Outlines Medicare Appeals Instructions for Hospitals

On Dec. 27, 2018, U.S. District Court for the District of Columbia issued an order in favor of the American Hospital Association (AHA) and the other plaintiffs in the lawsuit to stop the Centers for Medicare & Medicaid Services’ nearly 30 percent reduction in the reimbursement rate for 340B drugs as exceeding the statutory authority of the Department of Health and Human Services. ​

The court also has asked for further briefing from the parties as to the appropriate remedy; under the court’s schedule, the first brief is due Jan. 26, 2019, although because of the government shutdown the court may extend that deadline.  

While the litigation remains active, AHA recommends that hospitals continue to pursue appeals for 2018 and initiate appeals for reduced payments in 2019. Specifically, 340B participating hospitals affected by the rule should continue to take steps, outlined in this memo, to request review of 340B claims in order to preserve the hospitals’ right to seek the full reimbursement amounts under the 2017 rate (the rate in effect prior to the near 30 percent cut) pending the final outcome of litigation.

For questions, contact Lawrence Hughes at lhughes@aha.org or 202-626-2346 or Shira Hollander at shollander@aha.org  or 202-626-2329.