Click here to view our June 2020 issue of Plan Sponsor News! This publication is designed to help large employers, union groups and self-insured companies understand their drug benefit design. In this issue, you'll read about: The Impact of COVID-19 on PBM Contracts Key Items in Pharmacy Benefit Manager Contracts Understand the Truth About PBMs and Manufacturer Rebate Revenue Embrace Reverse Auction Procedure and Protect Plan Dollars with Proper Contractual Tools...
A group of New York BlueCross BlueShield health plans have filed suit against Walgreens, the largest community pharmacy chain, in U.S. District Court for the Northern District of Illinois alleging Walgreens inflated usual and customary (U&C) charges and obfuscated cash pricing information for most of the drugs eligible for its discount program. The lawsuit follows a $269 million settlement on January 19, 2019 for claims brought by the U. S.,...
Additional FAQ Released Regarding Recent Practice Acquisitions As you are likely aware, the U.S. Department of Health and Human Services (“DHHS”) has allocated a total of $50 billion in Provider Relief Funds for general distribution to Medicare Part A and Part B-billing healthcare providers. These Provider Relief Funds were authorized under the Coronavirus Aid, Relief, and Economic Security Act (“CARES Act”) and are intended to assist healthcare providers in covering...
May 22, 2020 |
By: Frier Levitt Frier Levitt Co-founder Jonathan Levitt, Esq. and pharmacist-attorney Dae Y. Lee, Pharm.D., Esq., CPBS discuss some of the often untold truths about PBMs and manufacturer rebates in a recent issue of Benefits Pro. "Plan sponsors are far too trusting of pharmacy benefit managers (PBMs) when it comes to understanding drug manufacturer rebate revenue. Rebate administration is one of the main services that PBMs offer to governmental entities, self-funded employers, insurers, and managed...
In response to the COVID-19 pandemic, and the overwhelming need for medical care and front-line responders, federal and state governments have responded by implementing regulations affording immunity to licensed healthcare providers. While the immunity may not prevent a healthcare provider from actually being sued for negligence, since public access to courts cannot be limited, it does provide protection for providers to defend against lawsuits. Likewise, the regulations provide immunity from...
