12620 Federal Register / Vol. 77, No. 41 / Thursday, March 1, 2012 / Notices 

1See, Speech by Christine Varney, Assistant 

Attorney General Antitrust Division, U.S. 

Department of Justice at American Bar Association/ 

American Health Lawyers Association Antitrust in 

Healthcare Conference, May 24, 2010. 

2801 Alaskan Way Suite 300—Pier 70 

Seattle, WA 98121–1128 

dlundsgaard@grahamdunn.com 

3. Counsel for Billings Clinic; Bozeman 

Deaconess Health Services, Inc.; 

Community Medical Center, Inc.; 

New West Health Services, Inc.; 

Northern Montana Health Care, 

Inc.; and St. Peter’s Hospital: 

Kevin P. Heaney 

Crowley Fleck PLLP 

Transwestern Plaza II 

490 N. 31st St., Suite 500 

Billings, MT 59101 

kheaney@crowleyfleck.com 

/s/ Scott I. Fitzgerald 

Scott I. Fitzgerald, 

Antitrust Division, U.S. Department of 

Justice, 450 Fifth Street NW., Suite 4100, 

Washington, DC 20530, (202) 353–3863, 

scott.fitzgerald@usdoj.gov. 

AMA—AMERICAN MEDICAL 

ASSOCIATION 

James Madara, Executive Vice President, 

CEO 

American Medical Association 

515 N. State Street 

Chicago, Illinois 60654 

amarassn.org 

(p) 312.464.5000 

(f) 312.464.4184 

January 13, 2012 

Mr. Joshua H. Soven, 

Chief, Litigation I Section, 

Antitrust Division, 

United States Department of Justice, 

450 5th Street, N, Suite 4700, 

Washington, DC 20530. 

Re: Comments to Proposed Consent 

Judgment in U.S. v. Blue Cross and 

Blue Shield of Montana, Inc., et al. 

[FR Doc. 2011–29656] 

Dear Mr. Soven: 

On behalf of the physician and 

medical student members of the 

American Medical Association (AMA), I 

appreciate the opportunity to provide 

comments in response to the action by 

the Antitrust Division of the Department 

of Justice (DOJ) in the matter of Blue 

Cross and Blue Shield of Montana, Inc. 

(Blue Cross) and several Montana-area 

hospitals (the Hospital Defendants) in 

U.S. v. Blue Cross and Blue Shield of 

Montana, Inc., et al., Civil Action No. 

1:11–cv–00123–RFC. This action 

represents an important step towards 

reining in health insurers and hospitals 

whose actions conspire to restrain 

competition and maintain monopolized 

health insurance markets. 

Accordingly, the DOJ has acted in the 

public interest with the proposed 

decree, and the AMA submits the 

following comments in support. 

According to the DOJ’s complaint, Blue 

Cross agreed to pay $26.3 million to the 

Hospital Defendants in exchange for 

their agreement to collectively stop 

purchasing health insurance from New 

West Health Services, an insurer owned 

by the Hospital Defendants, and instead 

buy from Blue Cross exclusively for six 

years (the Agreement). The Agreement, 

it is alleged, would likely cause New 

West to exit the relevant Montana 

markets for commercial health 

insurance. Because New West is Blue 

Cross’s only viable competitor, the 

Agreement would have eliminated all 

competition. Accordingly, as the 

Complaint alleges, the Agreement 

would have led to higher prices and 

lower quality service for consumers. 

The AMA applauds the DOJ for its 

vigilance in recognizing the 

anticompetitive conduct described 

above and for fashioning a remedy that 

holds the promise of nurturing 

competition in Montana. For years, the 

AMA has been expressing its concern 

over the lack of competition in health 

insurance markets nationally. In its 

most recent study of health insurance 

markets, the AMA found that 83% of 

the 368 metropolitan areas studied 

qualify as highly concentrated areas, 

while in 95% of these markets, at least 

one insurer has a market share of 30% 

or greater. See, ‘‘Competition in Health 

Insurance: A Comprehensive Study of 

U.S. Markets,’’ American Medical 

Association (AMA) (2011 update). 

Health insurance markets that are 

monopolized not only hurt consumers 

directly, they also enable health insurers 

to exercise monopsony power in 

physician markets, eventually leading to 

reductions in service levels and quality 

of care. The market conditions in 

Montana are consistent with what the 

AMA has found nationally. 

Blue Cross’ dominance in Montana 

health insurance markets presents a 

significant barrier to the market success 

of smaller rivals such as New West, 

even assuming the absence of 

exclusionary conduct such as that 

alleged in this case. In 2010, then 

Assistant Attorney General Christine 

Varney reported that the DOJ found that 

new health insurer entrants cannot 

compete with incumbents for potential 

purchasers of their products unless the 

new entrants can offer similar provider 

discounts to their enrollees—but they 

cannot offer these competitive discounts 

without being able to promise providers 

a significant number of enrollees to 

make such an arrangement viable. In 

turn, these barriers of entry create an 

anticompetitive environment in which 

the dominant insurer can achieve lower 

input prices by demanding lower rates 

from providers (who face a significant 

loss of revenue if they refuse such 

demands), without having to lower their 

consumer output prices (the cost of their 

premiums).1

In the instant case, the DOJ has 

fashioned a pro-competitive remedy that 

addresses the entry barriers faced by 

small Blue Cross rivals such as New 

West. First, the proposed final judgment 

would eliminate the anticompetitive 

effects of the challenged Agreement by 

requiring New West and the Hospital 

Defendants to divest New West’s 

commercial health insurance business. 

Tentative arrangements call for the 

acquiring entity to be PacificSource, 

which is an established health insurer 

in the Pacific Northwest. To overcome 

Blue Cross’ advantage in obtaining 

discounts from the Hospital Defendants 

because of its size, the proposed consent 

decree creatively requires New West 

and the Hospital Defendants to help 

provide PacificSource with a costcompetitive provider network. The 

Hospital Defendants are required to sign 

three-year hospital contracts with 

PacificSource on terms substantially 

similar to the existing contractual terms 

with New West. The decree also 

requires Blue Cross to provide thirty 

days’ written notice to the DOJ before 

entering into any exclusive contracts 

with health insurance brokers— 

contracts that might hinder important 

health insurer access to brokers. These 

provisions will help ensure that 

PacificSource will be able to compete as 

effectively as New West before the 

parties entered the Agreement. 

In sum, the divestiture of New West 

mandated in the proposed consent 

decree will reverse the anticompetitive 

effects of the challenged Agreement, 

while the additional provisions may 

foster an even more robust competition 

within the market than existed before 

the Agreement. Given the weak state of 

health insurer competition in Montana, 

we applaud the DOJ for creating this 

remedy in the public interest. 

Sincerely, 

James L. Madara, MD. 

[FR Doc. 2012–4862 Filed 2–29–12; 8:45 am] 

BILLING CODE M 

DEPARTMENT OF JUSTICE 

Drug Enforcement Administration 

Importer of Controlled Substances, 

Notice of Application, Mylan 

Pharmaceuticals, Inc. 

Pursuant to 21 U.S.C. 958(i), the 

Attorney General shall, prior to issuing 

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Federal Register / Vol. 77, No. 41 / Thursday, March 1, 2012 / Notices 12621 

a registration under this Section to a 

bulk manufacturer of a controlled 

substance in schedule I or II, and prior 

to issuing a regulation under 21 U.S.C. 

952(a)(2) authorizing the importation of 

such a substance, provide 

manufacturers holding registrations for 

the bulk manufacture of the substance 

an opportunity for a hearing. 

Therefore, in accordance with 21 CFR 

1301.34(a), this is notice that on 

December 30, 2011, Mylan 

Pharmaceuticals, Inc., 781 Chestnut 

Ridge Road, Morgantown, West Virginia 

26505, made application by letter to the 

Drug Enforcement Administration 

(DEA) to be registered as an importer of 

the following basic classes of controlled 

substances: 

Drug Schedule 

Amphetamine (1100) .................... II 

Methadone (9250) ........................ II 

Morphine (9300) ........................... II 

The company plans to import the 

listed controlled substances in finished 

dosage form (FDF) from foreign sources 

for analytical testing and clinical trials 

in which the foreign FDF will be 

compared to the company’s own 

domestically-manufactured FDF. This 

analysis is required to allow the 

company to export domesticallymanufactured FDF to foreign markets. 

Any bulk manufacturer who is 

presently, or is applying to be, 

registered with DEA to manufacture 

such basic classes of controlled 

substances may file comments or 

objections to the issuance of the 

proposed registration and may, at the 

same time, file a written request for a 

hearing on such application pursuant to 

21 CFR 1301.43, and in such form as 

prescribed by 21 CFR 1316.47. 

Any such written comments or 

objections should be addressed, in 

quintuplicate, to the Drug Enforcement 

Administration, Office of Diversion 

Control, Federal Register Representative 

(ODL), 8701 Morrissette Drive, 

Springfield, Virginia 22152; and must be 

filed no later than April 2, 2012. 

This procedure is to be conducted 

simultaneously with, and independent 

of, the procedures described in 21 CFR 

1301.34(b), (c), (d), (e), and (f). As noted 

in a previous notice published in the 

Federal Register on September 23, 1975, 

40 FR 43745–46, all applicants for 

registration to import a basic class of 

any controlled substance in schedule I 

or II are, and will continue to be, 

required to demonstrate to the Deputy 

Assistant Administrator, Office of 

Diversion Control, Drug Enforcement 

Administration, that the requirements 

for such registration pursuant to 21 

U.S.C. 958(a); 21 U.S.C. 823(a); and 21 

CFR 1301.34(b), (c), (d), (e), and (f) are 

satisfied. 

Dated: February 23, 2012. 

Joseph T. Rannazzisi, 

Deputy Assistant Administrator, Office of 

Diversion Control, Drug Enforcement 

Administration. 

[FR Doc. 2012–4992 Filed 2–29–12; 8:45 am] 

BILLING CODE 4410–09–P 

DEPARTMENT OF JUSTICE 

Drug Enforcement Administration 

Importer of Controlled Substances; 

Notice of Registration; Mylan 

Pharmaceuticals Inc. 

By Notice dated December 22, 2011, 

and published in the Federal Register 

on December 29, 2011, 76 FR 81978, 

Mylan Pharmaceuticals, Inc., 781 

Chestnut Ridge Road, Morgantown, 

West Virginia 26505, made application 

by renewal to the Drug Enforcement 

Administration (DEA) to be registered as 

an importer of the following basic 

classes of controlled substances: 

Drug Schedule 

Methylphenidate (1724) ................ II 

Oxycodone (9143) ........................ II 

Hydromorphone (9150) ................ II 

Fentanyl (9801) ............................ II 

The company plans to import the 

listed controlled substances in finished 

dosage form (FDF) from foreign sources 

for analytical testing and clinical trials 

in which the foreign FDF will be 

compared to the company’s own 

domestically-manufactured FDF. This 

analysis is required to allow the 

company to export domesticallymanufactured FDF to foreign markets. 

No comments or objections have been 

received. DEA has considered the 

factors in 21 U.S.C. 823(a) and 952(a), 

and determined that the registration of 

Mylan Pharmaceuticals, Inc. to import 

the basic classes of controlled 

substances is consistent with the public 

interest, and with United States 

obligations under international treaties, 

conventions, or protocols in effect on 

May 1, 1971. DEA has investigated 

Mylan Pharmaceuticals, Inc. to ensure 

that the company’s registration is 

consistent with the public interest. The 

investigation has included inspection 

and testing of the company’s physical 

security systems, verification of the 

company’s compliance with state and 

local laws, and a review of the 

company’s background and history. 

Therefore, pursuant to 21 U.S.C. 952(a) 

and 958(a), and in accordance with 21 

CFR 1301.34, the above named company 

is granted registration as an importer of 

the basic classes of controlled 

substances listed. 

Dated: February 23, 2012. 

Joseph T. Rannazzisi, 

Deputy Assistant Administrator, Office of 

Diversion Control, Drug Enforcement 

Administration. 

[FR Doc. 2012–4994 Filed 2–29–12; 8:45 am] 

BILLING CODE 4410–09–P 

DEPARTMENT OF JUSTICE 

Parole Commission 

Sunshine Act Meeting 

TIME AND DATE: 1:30 p.m., Thursday, 

March 8, 2012. 

PLACE: U.S. Parole Commission, 90 K 

Street NE., 3rd Floor, Washington, DC. 

STATUS: Closed. 

MATTERS TO BE CONSIDERED: 

Consideration of two original 

jurisdiction cases pursuant to 28 CFR 

2.27. 

CONTACT PERSON FOR MORE INFORMATION: 

Patricia W. Moore, Staff Assistant to the 

Chairman, U.S. Parole Commission, 90 

K Street NE., 3rd Floor, Washington, DC 

20530, (202) 346–7001. 

Dated: February 27, 2012. 

Rockne Chickinell, 

General Counsel, U.S. Parole Commission. 

[FR Doc. 2012–5183 Filed 2–28–12; 4:15 pm] 

BILLING CODE 4410–31–P 

MISSISSIPPI RIVER COMMISSION 

Sunshine Act Meetings 

AGENCY: Agency Holding the Meetings: 

Mississippi River Commission. 

DATES: Time and Date: 9 a.m., March 26, 

2012. 

Place: On board MISSISSIPPI V at 

River Park, Tiptonville, TN. 

Status: Open to the public. 

Matters To Be Considered: (1) 

Summary report by President of the 

Commission on national and regional 

issues affecting the U.S. Army Corps of 

Engineers and Commission programs 

and projects on the Mississippi River 

and its tributaries; (2) District 

Commander’s overview of current 

project issues within the Memphis 

District; and (3) Presentations by local 

organizations and members of the 

public giving views or comments on any 

issue affecting the programs or projects 

of the Commission and the Corps of 

Engineers. 

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