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
In the past week alone, Frier Levitt has seen a sudden increase in actions by pharmaceutical manufacturers against pharmacies related to the use of certain patient savings programs, such as copay coupon programs. These programs are designed to... Read More
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
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
On June 29, 2022, the Department of Justice (“DOJ”) announced the formation of the New England Prescription Opioid (NEPO) Strike Force. This strike force will investigate and vigorously prosecute healthcare providers involved in healthcare fraud... Read More
After a decade-long wait, the Food and Drug Administration finally issued a proposed rule in late June that would make it easier for pharmaceutical companies to switch products from prescription-only to over-the-counter status while still retaining... Read More
In a recent trend, compounding pharmacies have been receiving notices of audit from the Office of Inspector General (“OIG”) of the U.S. Department of Health and Human Services (“HHS”). In the notice, OIG requests that the pharmacies submit... Read More
On May 9, 2022, the Centers for Medicare and Medicaid Services (CMS) released a Final Rule (Final Rule) entitled, “Contract Year 2023 Policy and Technical Changes to the Medicare Advantage and Medicare Prescription Drug Benefit Programs.” ... Read More
Pharmacy benefit managers (PBMs) regularly conduct audits on pharmacies to review their performance in relation to the PBM’s terms and conditions. There are several different types of compliance audits that PBMs may initiate, such as desktop,... Read More
The New York Department of Health (NYDOH) has promulgated enrollment requirements for pharmacies seeking to participate in the Medicaid program which are unrelated to many of the actual operations of pharmacies within the state of New York.... Read More
