Earlier this month, the Centers for Medicare and Medicaid (“CMS”) released a Memorandum overviewing next steps in the federal government’s implementation of the Medicare Drug Price Negotiation Program. Though CMS has only just “set the... Read More
Articles | Manufacturers | Medicare, Medicaid, and Other Commercial Payor Audits & Appeals | Pharmaceutical Manufacturers

State Boards of Pharmacy (“BOPs”) throughout the country are empowered through various laws, rules, and regulations governing administrative agencies, like BOPs, to handle issues with the licensees they regulate, including pharmacies and... Read More
Articles | Chain Pharmacies | Clinically Integrated Networks (CINs) | Community Oncology Practices & Other Dispensing Physician Practices | Community, Retail Pharmacies | Digital Pharmacies | Fertility Pharmacies | Home Infusion Providers | Integrated Delivery Network and Hospital System Pharmacy | Long-Term Care Pharmacies | National Board of Pharmacy Matters | Specialty Pharmacies | State Board of Pharmacy Hearings and Professional Discipline | Supermarket Pharmacies | Traditional Compounding Pharmacies (503A) | Veterinary Compounders

Frier Levitt successfully assisted a Georgia-based pharmacy in securing reimbursement exceeding $1.2 million due and owed to the pharmacy from a major Pharmacy Benefit Manager (“PBM”). The PBM conducted multiple audits of the pharmacy including... Read More
Antitrust Tools Available to Combat PBM Abuse of Pharmacies | Articles | Biotech Companies | Chain Pharmacies | Clinically Integrated Networks (CINs) | Community, Retail Pharmacies | Defending Pharmacies in PBM Audits | Digital Pharmacies | Fertility Pharmacies | Integrated Delivery Network and Hospital System Pharmacy | Long-Term Care Pharmacies | News | Recent Results | Recent Successes | Specialty Pharmacies | Supermarket Pharmacies | Traditional Compounding Pharmacies (503A) | Veterinary Compounders

With the start of 2023, an amendment to Tennessee Legislation requiring that Pharmacy Benefit Managers (“PBMs”) reimburse Tennessee Pharmacies at least the actual cost of the drug, or align with Tennessee Medicaid reimbursement rates, has taken... Read More
Antitrust Tools Available to Combat PBM Abuse of Pharmacies | Articles | Chain Pharmacies | Community Oncology Practices & Other Dispensing Physician Practices | Community, Retail Pharmacies | Defending Pharmacies in PBM Audits | Digital Pharmacies | DIR Fees | Life Sciences | Pharmacy Law | Specialty Pharmacies

On Thursday, January 12, 2023, Governor Ron DeSantis announced a legislative proposal to regulate “unchecked” Pharmacy Benefit Managers (“PBMs”) operating in Florida. According to Governor DeSantis, the proposed legislation is designed to... Read More
Antitrust Tools Available to Combat PBM Abuse of Pharmacies | Articles | Community, Retail Pharmacies | Defending Pharmacies in PBM Audits | Digital Pharmacies | Life Sciences | Pharmacy Law | Specialty Pharmacies | State and National Pharmacy Associations | Supermarket Pharmacies

Drug manufacturers and patients are being negatively impacted by the increasing use of insurer copay accumulator and maximizer programs. These programs prevent manufacturer assistance, such as co-pay coupons, from being applied towards a patient's... Read More
Articles | Life Sciences | Manufacturers | Pharmacy Law

State Boards of Pharmacy (“BOPs”) throughout the country rely on various types of proceedings, both formal and informal, to handle legal issues with licensees (pharmacies, pharmacists, etc.) conducting business in their state. Oftentimes, less... Read More
Articles | Chain Pharmacies | Community, Retail Pharmacies | Digital Pharmacies | Fertility Pharmacies | Integrated Delivery Network and Hospital System Pharmacy | Life Sciences | Long-Term Care Pharmacies | National Board of Pharmacy Matters | Pharmacy Law | Specialty Pharmacies | State Board of Pharmacy Hearings and Professional Discipline | Supermarket Pharmacies | Traditional Compounding Pharmacies (503A) | Veterinary Compounders

On August 3, 2022, an Illinois federal jury returned a verdict ordering Eli Lilly & Co. (“Eli Lilly”) to pay $61 million for violations of the Federal False Claims Act (“FCA”) and adjacent state FCA laws. According to a qui tam lawsuit... Read More
Articles | Biotech Companies | MAC Pricing & Appeals | Manufacturers | Maximum Allowable Cost Pricing & Appeals | Pharmaceutical Manufacturers

A New York-based pharmacy client was facing an audit conducted by a major pharmacy benefit manager (“PBM”). During the audit, the PBM conducted an invoice reconciliation, causing it to assert thousands of unsubstantiated claims. In fact, the PBM... Read More
Articles | Chain Pharmacies | Community, Retail Pharmacies | Defending Pharmacies in PBM Audits | Digital Pharmacies | Fertility Pharmacies | Integrated Delivery Network and Hospital System Pharmacy | Long-Term Care Pharmacies | News | Recent Results | Recent Successes | Specialty Pharmacies | Supermarket Pharmacies | Traditional Compounding Pharmacies (503A)

Having served for nearly a decade as a federal prosecutor with the Department of Justice (“DOJ”), I always understood that whether a violation of the Anti-Kickback Statute (“AKS”) will result in criminal charges versus a civil lawsuit for... Read More
Articles | Chain Pharmacies | Community, Retail Pharmacies | Digital Pharmacies | Federal and State Fraud and Abuse Counseling | Federal and State Fraud and Abuse Counseling | Fertility Pharmacies | Integrated Delivery Network and Hospital System Pharmacy | Long-Term Care Pharmacies | Specialty Pharmacies | Supermarket Pharmacies | Traditional Compounding Pharmacies (503A) | White Collar Criminal Defense & Government Investigations | White Collar Defense and Government Investigation