When looking to purchase a pharmacy, prospective owners must take into consideration multiple aspects of the transaction in order to ensure a successful continuation of operations post-closing. Failure to properly evaluate, structure, and execute a... Read More
As part of routine audits, Pharmacy Benefit Managers (“PBMs”) regularly request pharmacies to produce documents pertaining to prescription claims. Amongst the documents commonly requested are copies of prescriptions, prescription labels, and... Read More
Frier Levitt recently assisted a New York-based independent pharmacy that was placed under temporary payment suspension by a national Pharmacy Benefit Manager (“PBM”). Notably concerning, the temporary suspension was effectuated while the... Read More
In Wisconsin, Governor Tony Evers recently signed a bipartisan bill into law aimed at regulating pharmacy benefit managers (PBMs). This law, which was unanimously passed in the Wisconsin legislature, is significant for several reasons including... Read More
The “law” applicable to drug reimbursement encompasses an array of laws across 50 states, the territories, and the federal government. These laws and regulations determine what a “Plan Sponsor” (such as an insurance plan, State Medicaid... Read More
Independent pharmacies face numerous challenges and obstacles when being audited by pharmacy benefit managers (PBMs). One audit related tactic utilized by PBMs that is causing financial harm to independent pharmacies throughout the country is the... Read More
Throughout the country, several states have engaged in ongoing efforts to enact or enhance state laws aimed at regulating pharmacy benefit managers (PBMs) and certain PBM practices, including audit and reimbursement practices, causing economic harm... Read More
Frier Levitt was recently successful in reversing a Midwest pharmacy’s enrollment application denial by a major Pharmacy Benefit Manager (“PBM”). The PBM denied the pharmacy’s enrollment application alleging that the pharmacy was previously... Read More
We previously highlighted CMS’s pharmacy reimbursement rates for administration of the COVID-19 vaccine. At that time, CMS detailed the Medicare payment rates for COVID-19 vaccine administration were $28.39 to administer single-dose vaccines and... Read More
In a recent trend, pharmacies have begun receiving notices of termination not for billing errors or audit findings, but for claims inactivity. Specifically, several Pharmacy Benefit Managers, or PBMs, have been terminating pharmacies solely because... Read More
