One of the most challenging issues for independent pharmacies throughout the United States is the issue of pharmacy benefit managers’ (PBMs) reimbursement practices. There are numerous ways in which PBMs dictate reimbursement to independent... 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
Many pharmacies are faced with PBM audits resulting in final audit finding recoupments which can range from very large to very small dollar amounts. Many times, when the recoupment is smaller in sum, pharmacies may be inclined to forgo contesting... Read More
The specialty pharmacy space has proven to be a rewarding investment for private equity, as specialty medications typically lead the pharmacy trend cost curve, which will only continue as more than 60 new specialty medications expected to receive... Read More
Horizon Blue Cross Blue Shield of New Jersey (“Horizon”) recently sent letters out to certain specialty pharmacies, ambulatory surgical centers, and other licensed New Jersey healthcare providers and facilities who provide certain Out-of-Network... Read More
Over the last several years, several of the nation’s largest insurers, pharmacy benefits managers (PBMs), and specialty pharmacies have combined or consolidated into just a handful of vertically integrated healthcare conglomerates. This... Read More
Frier Levitt successfully reversed a five year wait for readmission for an independent pharmacy into one of the largest Pharmacy Benefit Managers (“PBM”) pharmacy networks. More specifically, the pharmacy was terminated by the PBM in 2017 for... Read More
If your pharmacy has been vandalized or looted in the recent riots that have affected many cities and towns across the country, depending on the issue, there may be a number of notifications that the pharmacy is required to make as it relates to the... Read More
PBM audits often follow certain trends which vary and evolve. One potentially emerging trend Frier Levitt has observed is that pharmacies who are undergoing audits with certain PBMs, namely OptumRx, are being asked to provide an actual copy of the... Read More
On May 19, 2020, the Department of Health and Human Services (HHS) issued guidance clarifying whether the Public Readiness and Emergency Preparedness (PREP) Act preempts State licensing laws that restrict pharmacists and pharmacies from ordering and... Read More
