Department of Justice challenging big insurers' "Most Favored Nation" clauses.
The DOJ's latest actions suggest that MFNs in managed care contracts should be evaluated on a case-by-case basis, focusing on the actual or potential impact that the MFNs have on price competition among providers and payors in the relevant marketplace. For health care providers desiring to avoid MFNs, however, the DOJ's heightened activity in this area might furnish an appropriate reason to resist such clauses. To date, the DOJ's focus has been on the market power of payors with MFN status. However, the DOJ's reasoning applies equally to providers that wield buying power in contracting with others. Although the DOJ has yet to take up this latter issue, MFNs imposed by increasingly powerful provider organizations can expect to receive similar scrutiny from the DOJ, especially as their market influence grows.
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D016363:Antitrust Laws; D003284:Contract Services / Q000191:economics / Q000331:legislation & jurisprudence; D004465:Economic Competition / Q000331:legislation & jurisprudence; D006077:Government Agencies; D007348:Insurance, Health / Q000191:economics / Q000331:legislation & jurisprudence*; D008329:Managed Care Programs / Q000331:legislation & jurisprudence*; D011907:Rate Setting and Review / Q000331:legislation & jurisprudence; D014481:United States