Frier Levitt represents Long-Term Care (LTC) Pharmacies on a wide array of legal and regulatory matters. Our team includes clinician attorneys and nationally recognized pharmacy industry leaders who have understand the complex relationships between LTC Pharmacies, government pharmacies, pharmaceutical manufacturers, wholesalers/distributors, and Pharmacy Benefit Managers (PBMs).
Background
LTC Pharmacies serve vulnerable patient populations including seniors in skilled nursing facilities (SNFs) and assisted living facilities (ALFS). The demographic changes towards the aging population have led LTC Pharmacies to become an increasingly important part of the healthcare system. However, economic pressures such as low generic reimbursement, PBM pricing tactics, and increasing regulatory demands have created significant challenges for LTC providers. With deep experience in both pharmacy operations and healthcare law, Frier Levitt helps pharmacies navigate these challenges and protect their businesses.
What We Do
Our attorneys have extensive experience challenging PBM and payor reimbursement and recoupment actions involving major PBMs such as CVS Caremark, Express Scripts, OptumRx, Humana, and Prime Therapeutics as well as public and private payors. We help LTC Pharmacies recover funds and resolve disputes involving effective rate reconciliation, Maximum Allowable Cost (MAC) pricing, and unreasonable reimbursement under Medicare Part D and commercial plans as well. Our efforts have saved clients millions of dollars.
As LTC Pharmacy operations expand, PBM and payor audits are becoming more frequent. These audits can disrupt operations and jeopardize contracts with Accountable Care Organizations, hospices, PACE programs, and long-term care facilities. Our attorneys are particularly familiar with the PBM contractual requirements on LTC Pharmacy requirement to enter prescription claims with particular NCPDP cod fields for pharmacy service time and patient resident codes. Our attorneys have successfully defended PBM and payor audits including Medicare Part D prescription drug plan, Medicare Advantage, Medicaid managed care, and commercial plans.
Our clinician-attorneys and regulatory experts guide LTC Pharmacies through federal and state requirements with respect to HIPAA, the Anti-Kickback law, the False Claims Act, and comparable state laws that present risk for civil or criminal liability. As part of the regulatory and compliance services, we conduct internal investigations/audits as well as vigorously defend our clients in the event of any investigations conducted by Federal and State agencies. Moreover, we have advised clients regarding self-reporting/disclosure to regulatory authorities and have limited client exposure.
Frier Levitt advises LTC Pharmacies in acquisitions, dispositions, restructuring and reorganizations, financing, development, and construction. With increasing private equity and investor interest in the pharmacy sector, we help clients structure deals strategically and position their businesses for long-term growth.
How Frier Levitt Can Help
Frier Levitt provides strategic, industry-focused legal counsel tailored to your needs. Contact our team today to learn how we can help you.