Resolving a 12-year anti-trust lawsuit, Blue Cross Blue Shield (BCBS) has agreed to a settlement amount of $2.8 billion, the largest ever for a health care anti-trust case. As part of the agreement, BCBS agrees to promulgate guidance that improves prior authorization (PA) processes, including recommendations of selective application of PA, a PA review program and volume adjustment, and increased transparency and efficiency in communication regarding prior authorization. In addition to dissemination of PA guidance to participating Blues Plans, BCBS will also create a system-wide information platform facilitating member benefits, eligibility verification and claims tracking.

The lawsuit alleged that BCBS and its affiliates established markets via exclusive service areas that reduced market competition, leading to increased insurance costs and driving down provider reimbursement. BCBS denies the allegations but agreed to the settlement to make operational changes so that it could put years of litigation behind it.