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Practical Tips You Should Follow When Submitting A Medicaid Application

As the national health care system evolves, controlling costs and abuses takes on greater significance in the federal health programs such as Medicare and Medicaid. The federal Department of Health and Human Services (DHHS) and its State counterparts have increasingly scrutinized Pharmacy applications seeking to provide (or continue to provide) prescription drug benefits to Medicaid recipients. This article addresses some common pitfalls. A pharmacy does not have a legal right...

Performing Compounding May Lead to a Battle with PBMs

Here are some suggestions on how to avoid being terminated from the PBM network: The number of compounding pharmacies is on the rise because of the profitability of compound prescription reimbursement received from cash paying customers. Often, a pharmacy owner will own two pharmacies, one in-network and a second out-of-network pharmacy to do the compounding. The out-of-network pharmacy can avoid the reduced PBM reimbursement for compounding because the cash paying...

My State is an “Any Willing Provider” State. What Does This Mean for My Pharmacy?

Many States have enacted "any willing provider" (AWP) legislation seeking to protect independent pharmacies. But, do these state laws work? AWP laws generally require health insurers, managed care organizations and other health plans to accept a pharmacy into their network if the pharmacy is willing to accept the terms and conditions of the contract. Contract terms include the fee schedule, covered expenses and the network's quality standards. A typical any...