On July 9, 2021, President Biden issued an executive order (EO) containing 72 directives to more than a dozen federal agencies, many of which have broad implications for healthcare. Specifically targeted are healthcare competition, hospital mergers,... Read More
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Frier Levitt recently helped an Arizona-based independent pharmacy that was being audited by a national PBM. The PBM alleged various audit discrepancies including inadequate proof of delivery and missing signature logs. These alleged discrepancies... Read More
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In a growing trend, we have seen Pharmacy Services Administrative Organizations (PSAOs) recently undertake new efforts to withhold reimbursements due and owing to pharmacies after they have been terminated by one or more pharmacy benefits managers... Read More
Blogs & Articles | Community, Retail Pharmacies | Defending Pharmacies in PBM Audits | Life Sciences | Pharmacy Law

The State of Texas recently enacted H.R. 3459, a law that permits prescribers to earn a “gold card” exemption from Prior Authorization (PA) requirements based on a track record of previous PA approvals from insurers (preferred provider and... Read More
Blogs & Articles | Life Sciences | Medicare, Medicaid, and Other Commercial Payor Audits & Appeals | Pharmacy Law

This article examines Pharmacy Benefit Manager’s (“PBM”) “rebate walls” and the impact on the United States drug supply chain.  The Federal Trade Commission head, Commissioner Rohit Chopra, recently issued a report on PBM rebate walls,... Read More
Blogs & Articles | Community, Retail Pharmacies | Defending Pharmacies in PBM Audits | Life Sciences | Pharmacy Law | Plan Sponsor PBM Contract Services

State legislative initiatives to regulate Pharmacy Benefit Managers (“PBMs”) have gained momentum.  Arkansas successfully defended its state PBM regulation in 2020 before the United States Supreme Court.  Now, more states have been enacting... Read More
Blogs & Articles | Community, Retail Pharmacies | Defending Pharmacies in PBM Audits | Life Sciences | Pharmacy Law | Regulatory Compliance, including FDA, DEA and HIPAA

As Congress has made changes to the health care system over the past 30 years, nothing has impacted consumers' lives as much as the growth of pharmacy benefit managers (PBMs). Most consumers might not think that PBMs play a large role in their... Read More
Blogs & Articles | Community, Retail Pharmacies | Defending Pharmacies in PBM Audits | Life Sciences | Maximum Allowable Cost Pricing & Appeals | News & Press | Pharmacy Law | Plan Sponsor PBM Contract Services

Earlier this year, we discussed the impact of mandatory “white bagging” on providers, and more importantly, patients. Briefly, white bagging is a practice where a medication is ordered by a physician for in-office administration (e.g., IV... Read More
Blogs & Articles | Community, Retail Pharmacies | Dispensing Physician Practices and Dispensing Physicians | Hospitals and Healthcare Systems | Pharmacy Law | Physician Dispensing

As we reported here, Plan Sponsors have begun elevating their challenges of Pharmacy Benefit Managers’ (“PBMs”) and Managed Care Organizations’ (“MCOs”) conduct, from PBM pricing  to auditing and litigating over PBM practices such as... Read More
Blogs & Articles | Community, Retail Pharmacies | Life Sciences | Pharmacy Law | Plan Sponsor PBM Contract Services