Health Policy Roundup: What Employers Need to Know About PBM Reform, Trump RX & Other Changes on the Horizon

Attorney Alan Arville provides strategic, transactional, and regulatory guidance to the health care industry.

His practice focuses on matters relating to the distribution, dispensing, and reimbursement of pharmaceuticals, including Medicare Part D, Medicare Advantage, the 340B Drug Discount Program, federal anti-kickback and anti-inducement laws, HIPAA privacy and security, health care licensing, drug purchase agreements, payor contracting, and affiliations and other collaborative arrangements. Alan’s clients include regional and national pharmacy chains; specialty pharmacies; health care systems; disproportionate share hospitals, federal grantees, and other 340B-covered entities; drug manufacturers and distributors; group purchasing organizations; and pharmacy services administrative organizations. Alan also devotes a substantial portion of his practice to representing private equity firms in the evaluation, due diligence, and acquisition of health care companies.

Pharmacies (chain and independent pharmacies, retailers with pharmacy operations, and specialty pharmacies) seek Alan’s advice on a diverse array of transactions and compliance issues. For example, Alan advises on patient reward and drug discount programs, manufacturer and third-party payor relations, Medicare Part D compliance, medication therapy management services, health and wellness programs, data sharing arrangements, 340B contract pharmacy arrangements, and limited distribution network and other specialty pharmacy models.

Health care providers, payers, digital health companies, and investors call on attorney Christine Burke Worthen for legal and strategic advice as they navigate complex regulatory and business challenges in the continuously evolving health care delivery and reimbursement landscape.

Her practical guidance enables clients across the health care ecosystem—health systems, hospitals, physician practices, digital health companies, behavioral health providers, third-party administrators, health plans, and investors—to implement both short- and long-term strategies that align with their organizational goals.

Christine possesses a wealth of experience working on matters concerning Medicare reimbursement, Medicare Advantage, participation in CMS Innovation Center payment models, managed Medicaid, managed care contract negotiations, and value-based payment arrangements with commercial payers, self-insured employers, and Medicare Advantage plans. She provides counsel on the regulatory, operational, and financial considerations necessary for maneuvering through the changing payment environment, including various forms of risk-based payment models, price transparency, revenue cycle and payment integrity, clinically integrated network development and value-based enterprise models, risk adjustment, and provider compensation arrangements.

Kim Thiboldeaux is a seasoned, passionate health care leader with experience in both the private and non-profit sectors, spanning multiple disease areas and health care topics including HIV and AIDS, organ transplant, oncology, caregiving, patient navigation, and health equity.

Kim served as CEO of the Cancer Support Community (CSC) for 20 years, from 2000-2020, leading a global nonprofit network that operates at 175 locations, including CSC and Gilda’s Club centers, and in multiple hospitals and cancer clinics. Combined with a toll-free Helpline, a Research Institute, and a DC-based Policy Institute, Kim grew this network of professionally-led services five-fold during her tenure. In her last year as CEO, the organization provided more than $50 million in free support and navigation services to patients and families.

Kim’s service includes appointments to the nation’s premier health care panels and boards. In 2019, Dr. Francis S. Collins, Director of the National Institutes of Health, appointed Kim to the Novel and Exceptional Technology and Research Advisory Committee. This panel is focused on providing advice and serving as a transparent forum for discussion of the scientific, safety, and ethical issues associated with emerging biotechnologies. In 2017, Kim was appointed to serve on the Biden Cancer Initiative’s Board of Directors.

In serving as a patient advocate on these high-profile boards and panels, Kim has brought attention to inequities in our health care system. In 2019, she joined Navajo Nation President Jonathan Nez, Dr. Jill Biden, and leaders of the Tuba City Regional Health Care Corporation in Arizona to mark the opening of the first-ever full-time cancer and support center on an American Indian Reservation. Kim helped convene key Navajo Nation leaders, private sector supporters, and other officials to establish this culturally-adapted program located in an area larger than the state of West Virginia. That work led to the opportunity to develop a full-length, feature documentary, Navajo Nation USA, about the cancer center and the triumphs and challenges of the Navajo people. Kim is Executive Producer and Writer on the film (www.NavajoNationUSA.com).

In 2020, Stand Up To Cancer appointed Kim to its Equity Breakthrough Research Review Team, focusing on cancers affecting underrepresented populations. In 2019, the International Psychosocial Oncology Society presented Kim with the President’s Community Award for Distinguished Contributions at its Global Congress in Canada.

Kim has led numerous other initiatives to help patients and families in need. Most notably, she launched an emergency fund in the wake of the COVID-19 pandemic that provided financial relief grants to thousands of patients affected by the economic downturn and expanded the organization’s professionally-staffed Helpline as the call volume nearly doubled. In addition, as part of a two-year collaboration she led with Airbnb, more than 3,000 patients in need were provided free housing while traveling for treatment.