Judge Lets Atrium Copay Program Move Forward After Expedited Hearing
The ruling keeps Atrium’s copay-reduction plan intact and preserves lower out-of-pocket costs for members who use Atrium providers.
Overview
- An expedited injunction hearing was held Tuesday in Lee County before Judge Matthew Houston to consider the State Health Plan’s request to block Atrium’s Affordability Protection Program.
- The judge denied a temporary restraining order and allowed Atrium’s program to proceed, though the State Health Plan says it will pursue additional legal options.
- The State Health Plan and Treasurer Brad Briner sued Atrium, arguing the system illegally tried to set copays reserved by state law to the treasurer and that the program could violate federal Stark rules.
- Atrium says the program, announced Oct. 6, will lower copays for participating State Health Plan members at Atrium facilities and that the system is absorbing costs to preserve patient access after its earlier discount offers were rejected.
- The dispute prompted the State Health Plan to extend open enrollment through Nov. 6 and highlights broader stakes for roughly 750,000 members and the plan’s multi-hundred-million-dollar projected deficits that led to a new tiered provider structure for 2027.