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Are Insurance Carriers In Trouble? Why Should You Care?

As the Affordable Care Act (ACA) continues to influence and change the healthcare landscape, innovation in the method of delivery of healthcare is at the forefront of the shifting dynamic between healthcare providers, insurance carriers and patients. The ACA has paved the way for healthcare systems to expand their roles beyond simply providing healthcare to patients, and one manner in which this is occurring is the development of self-funded insurance...

Frier Levitt Secures Complete Victory On Behalf of Anesthesia/Pain Management Practice and its Physician Members, Avoiding $1.4 Million Claim

Frier Levitt attorney Jonathan E. Levitt, Esq., secured a complete trial victory in Bergen County New Jersey in a month-long bench trial for a prominent New Jersey Medical Practice specializing in anesthesiology and pain management. Following a full trial, the Chancery Judge issued an eighteen page opinion dismissing the Plaintiff’s complaint in its entirety, denying Plaintiff’s right to monetary damages, and denying Plaintiff’s requested relief to be deemed a “Member”...

Georgia Board of Pharmacy Enacts Rules Requiring Licensure of Non-Resident Pharmacies

The Georgia Board of Pharmacy (“BOP”) recently enacted rules governing the licensure of pharmacies outside of Georgia that dispense medications into the State of Georgia.  As many of you know, the State of Georgia did not previously require non-resident pharmacies to obtain a license in order to ship medications into the State of Georgia. That all changed in July 2013 when the Georgia legislature enacted Ga. Code Ann. §26-4-114.1 requiring...

Payors Start Requesting Medical and Scientific Evidence from Physicians Prescribing Compounds: Is Your Referring Physician Prepared?

In the latest trend of compound coverage and reimbursement, certain payors have begun requesting medical and scientific evidence directly from physicians prescribing compounds, as part of their determination as to whether a given prescription should be covered. For some time, certain PBMs have “required” two peer reviewed studies from the billing pharmacy for every ingredient contained within the compound. Conversely, other PBMs have been calling doctors urging them to prescribe...

DEA’s Rescheduling of Compounds Containing Hydrocodone and Oxycodone Means Tighter Restrictions by PBMs and State Regulatory Boards

On August 22, 2014, the United States Drug Enforcement Administration (DEA) published a notice in the Federal Register announcing the reclassification of Hydrocodone Combination Products (HCPs) as Schedule II narcotics under the Controlled Substances Act, 21 U.S.C. §§ 801, et. seq (the CSA). Under the new rule, any combination painkiller containing hydrocodone or oxycodone constitutes a Schedule II narcotic. The rule applies to widely used, name brand HCPs, such as...