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»  Posts By   November 2016 

Top 10 Hot Legal Topics in Specialty Pharmacy

In this video, Partner Jesse C. Dresser, Esq., discusses the Top 10 Hot Legal Topics in Specialty Pharmacy, including Specialty Pharmacy Network Admission; access to Limited Distribution Drugs; PBM and Payor audits; Pharmacy-Pharmaceutical Manufacturer Arrangements; Financial Transactions, including Private Equity investment and Mergers & Acquisitions; Hub Models; Reimbursement Rates and DIR Fees; Accreditation Requirements; Government Investigations; and the 340B Drug Discount Program. If you have questions regarding your Specialty Pharmacy, contact...

HIPAA Sentencing Results in Home Confinement and Probation

Several pharmaceutical district sales managers were fined and sentenced to probation, home confinement, or a combination of the three, for violations of the Health Insurance Portability and Accountability Act (HIPAA). One district manager was charged with filling out prescription prior authorizations on behalf of physicians in an effort to increase sales numbers, and instructing his representatives to do the same. The district manager was also said to have ignored a...

Importance of Proper Pain Management Evidenced by Increasing Hospitalizations for Opioid Poisonings

A recent study reported by the Journal of the American Medical Association (JAMA) has indicated that a parallel relationship exists between recent trends in opioid prescribing practices and hospitalization for opioid poisonings in children and adolescents. The study, released on October 31, 2016, concludes that, during the course of sixteen years, hospitalizations attributed to opioid poisonings in children and adolescents, or more generally, the pediatric population, have risen nearly two-fold....

Trends in Payor Contracting Strategies for Specialty Pharmacies

    As the specialty pharmacy industry has exploded, payors and Pharmacy Benefits Managers (PBMs) have adopted a variety of different tactics and strategies for contracting with specialty pharmacies. From "closed" networks to tiered admission criteria, specialty pharmacies face a veritable labyrinth when seeking to contract with payors and PBMs. This webinar will cover different network designs used by payors, trends in credentialing procedures, and medical-benefit versus pharmacy benefit reimbursement....

CLASS ACTION ALERT: Pharmacy Benefit Managers (PBMs) Are Tricking Patients Into Paying Higher Copayments Than The Actual Cash Price For Their Medications

We are receiving information about a disturbing new trend involving potential price gouging by PBMs. PBMs may have been charging patients  copayments for prescription drugs that exceed the actual cash price of the drug. PBMs later recoup from the Pharmacy the difference in value between the price of the drug and the higher copayment Patient lose by paying more than reasonably required. PBMs win.  PBMs, who serve as the middle...
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