A major trend in pharmacy throughout 2016 was the continued diminution of reimbursement rates for pharmacies by PBMs and Plan Sponsors, as well as the exclusion of independent pharmacies from PBMs’ “restricted” provider networks. Many pharmacies have continued to see their margins shrink because of below market pricing and the PBM industry’s imposition of post-adjudication “DIR Fees.” In particular, the impact of “DIR Fees” on independent pharmacies has been immense, as pharmacies have been assessed millions of dollars of fees in 2016 alone based upon their “performance” when compared with opaque quality metric criteria. Other pharmacies have been wrongfully excluded from PBMs’ “Preferred Cost Sharing Networks,” and such wrongful exclusion allows PBMs to continue steering patients toward their wholly-owned pharmacies.
In light of this, Frier Levitt utilized a number of federal and state laws in 2016, including Any Willing Provider laws and Prompt Payment laws, to successfully challenge these and many other abusive PBM policies on behalf of pharmacies throughout the country. Frier Levitt was successful in challenging unreasonable reimbursement rates of independent specialty pharmacies, and was similarly successful in challenging the PBM industry’s wrongful exclusion of independent pharmacies from restricted pharmacy networks. In 2017, Frier Levitt will continue to employ all available legal strategies to ensure that independent pharmacies are not exploited by the PBM industry. If your pharmacy is dealing with unreasonable reimbursement rates, contact Frier Levitt to speak to an attorney.
