A piece of legislation aimed at regulating pharmacy benefit managers (PBMs) and protecting Independent Pharmacies in the State of Tennessee recently passed through the State’s House and Senate and was subsequently signed into law by Governor Bill... Read More
Frier Levitt successfully lifted a payment suspension imposed by a major Pharmacy Benefit Manager ("PBM") upon an independent pharmacy based in New York. The PBM effectuated the payment suspension shortly after conducting an audit but prior to... Read More
Frier Levitt recently assisted a New Jersey-based specialty pharmacy audited by a large health plan and its PBM which had placed over $500,000 at issue through various audit discrepancies, including alleged invalid prescriptions, insufficient proof... Read More
Frier Levitt recently helped a New York-based independent pharmacy that was being audited by a PBM. Frier Levitt worked with the pharmacy and the PBM to successfully reduce the audit discrepancies by more than 90%. The PBM alleged various audit... Read More
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
