As the Pharmacy Benefit Managers (PBMs) prepare for the end-of-year “housekeeping”, pharmacies should be aware of the PBM audit trends and arm themselves with information necessary to preempt—and strategies to outright avoid—falling victim... Read More
Antitrust Review and Compliance | Antitrust Tools Available to Combat PBM Abuse of Pharmacies | Articles | Biotech Companies | 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 | Specialty Pharmacies | Supermarket Pharmacies | Traditional Compounding Pharmacies (503A) | Uncategorized

The recent increase in proposed State Legislature across the U.S. in an effort to regulate Pharmacy Benefit Managers (“PBMs”) demonstrates rising scrutiny by the government into the abusive conduct of PBMs and the impact it has on American... Read More
Antitrust Tools Available to Combat PBM Abuse of Pharmacies | Plan Sponsor PBM Contract Services

Independent pharmacies and providers must be vigilant based on a recent uptick in network terminations (many of which are not justified) by pharmacy benefit managers (“PBMs”) throughout the country. The fact that PBMs will often issue... Read More
Antitrust Tools Available to Combat PBM Abuse of Pharmacies | Articles | Chain Pharmacies | Community, Retail Pharmacies | Defending Pharmacies in PBM Audits | Digital Pharmacies | Fertility Pharmacies | Long-Term Care Pharmacies | Payor Network Access and Defense of Network Terminations | Specialty Pharmacies | Supermarket Pharmacies | Traditional Compounding Pharmacies (503A)

Rising drug prices have forced consumers to seek out and utilize the most affordable sources to obtain their prescription medications. Whether it’s through commercial insurance, prescription discount cards, or manufacturer assistance programs,... Read More
Antitrust Tools Available to Combat PBM Abuse of Pharmacies | Articles | Chain Pharmacies | Clinically Integrated Networks (CINs) | Community Oncology Practices & Other Dispensing Physician Practices | Community, Retail Pharmacies | Defending Pharmacies in PBM Audits | Digital Pharmacies | Fertility Pharmacies | Hospitals and Healthcare Systems | Integrated Delivery Network | Integrated Delivery Network and Hospital System Pharmacy | Physician Dispensing | Regulatory Compliance, including FDA, DEA and HIPAA | Risk Assessment Mitigation Strategy | Specialty Pharmacies | Supermarket Pharmacies | Traditional Compounding Pharmacies (503A)

Pharmacy Benefit Managers (“PBMs”) regularly review network pharmacies to ensure that they are meeting terms and conditions identified in their Provider Agreements and Pharmacy Manuals. One mechanism for this review includes audits and... Read More
Antitrust Tools Available to Combat PBM Abuse of Pharmacies | Articles | Chain Pharmacies | Community, Retail Pharmacies | Defending Pharmacies in PBM Audits | Digital Pharmacies | Fertility Pharmacies | Specialty Pharmacies | Supermarket Pharmacies | Traditional Compounding Pharmacies (503A)

Frier Levitt was recently successful in assisting a New Jersey-based specialty pharmacy with the reversal of a full audit chargeback of over $100,000 plus the additional audit fee. A major PBM had conducted an extensive audit on the pharmacy and... Read More
Antitrust Tools Available to Combat PBM Abuse of Pharmacies | Chain Pharmacies | Community, Retail Pharmacies | Defending Pharmacies in PBM Audits | Digital Pharmacies | Fertility Pharmacies | Long-Term Care Pharmacies | News | Recent Results | Recent Successes | Specialty Pharmacies | Supermarket Pharmacies | Traditional Compounding Pharmacies (503A)

As Pharmacy Benefit Managers (PBMs) review participation in their retail pharmacy networks, pharmacy providers find themselves at risk of termination over past audit results. We have recently seen a significant increase in a particular PBM... Read More
Antitrust Review and Compliance | Antitrust Tools Available to Combat PBM Abuse of Pharmacies | Articles | Biotech Companies | Chain Pharmacies | Community, Retail Pharmacies | Defending Pharmacies in PBM Audits | Digital Pharmacies | Fertility Pharmacies | Integrated Delivery Network | Integrated Delivery Network and Hospital System Pharmacy | Long-Term Care Pharmacies | Payor Network Access and Defense of Network Terminations | Specialty Pharmacies | Supermarket Pharmacies | Traditional Compounding Pharmacies (503A)

Frier Levitt recently assisted a California-based independent pharmacy that faced an audit from a major pharmacy benefit manager (“PBM”) by successfully challenging the audit findings and reversing 100% of the purported discrepancies.  During... Read More
Antitrust Tools Available to Combat PBM Abuse of Pharmacies | Articles | Defending Pharmacies in PBM Audits | DIR Fees | Life Sciences | News | Pharmacy Law | Recent Results

Pharmacy benefits manager (PBM) Caremark has now placed Trimester 1 Reports for year 2022 in the Caremark Provider Portal.  Caremark provides its summaries of Direct and Indirect Remuneration (DIR) Fees paid by participating pharmacy providers for... Read More
Antitrust Tools Available to Combat PBM Abuse of Pharmacies | Articles | Community, Retail Pharmacies | Defending Pharmacies in PBM Audits | Digital Pharmacies | DIR Fees | Life Sciences | Medicare, Medicaid, and Other Commercial Payor Audits & Appeals | Pharmacy Law | Specialty Pharmacies

New York’s Pharmacy Benefits Bureau (“Bureau”) has requested input from the public on three separate occasions regarding New York’s laws governing Pharmacy Benefit Managers (PBMs). The Bureau has now issued its Fourth Request for Public... Read More
Antitrust Tools Available to Combat PBM Abuse of Pharmacies | Articles | Community, Retail Pharmacies | News | Pharmacy Law | Specialty Pharmacies