Chapel Hill-based UNC Health has filed lawsuits against Aetna and Humana, alleging both insurers underpaid for 340B drug claims in violation of their contractual agreements.
The lawsuits, filed June 10 in a North Carolina federal court, claim the payers improperly reduced reimbursement rates for 340B drugs provided at UNC hospitals between 2018 and 2022. The 340B drug pricing program allows eligible providers to purchase discounted drugs, helping facilities serving vulnerable populations.
UNC argues that the underpayments resulted from the insurers’ application of a federal payment reduction policy later deemed unlawful by the U.S. Supreme Court in 2022. The court’s unanimous ruling reversed a lower court’s decision, declaring that CMS’ reimbursement cuts to 340B hospitals in 2018 and 2019 were unlawful, citing the detrimental impact the cuts had on hospitals serving low-income and rural communities. The Court noted that the cuts affected about $1.6 billion annually in federal funding.
In the complaint, Humana is accused of improperly applying a 22.5% discount to 340B drug claims under its Medicare Advantage plans, instead of reimbursing based on the statutory rate of average sales price plus 6%. Similarly, Aetna is alleged to have applied the same unlawful discount to 340B drug claims for its Medicare Advantage members.
The health system is seeking restitution for the alleged underpayments and demanding that both insurers honor their contractual obligations under the MA agreements. Specifically, UNC is requesting a judgment to compel the insurers to reimburse the system for the full amount they are allegedly owed, plus additional damages exceeding $75,000. UNC is also seeking a court order to ensure the insurers comply with the correct payment structure moving forward.
A Humana spokesperson told Becker’s the company would not comment on pending litigation, while an Aetna spokesperson said the company denies the allegations and intends to defend itself vigorously.
