Jesse Dresser, Steven Bennet and A.J. Barbarito author article on The Law of Drug Reimbursement for Total Pharmacy
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 program, or Medicare Part D Plan) or pharmacy benefits manager (PBM) may or must reimburse network pharmacies. These laws can generally be grouped into several different categories, including: Maximum Allowable Cost (“MAC”) or fair reimbursement laws; post point of sale (PPOS) adjustment restrictions, and Any Willing Provider laws (AWPLs). In turn, many states have enacted different aspects of these laws regulating commercial insurance or Medicaid plans in their states, whereas the federal government has implemented certain provisions regulating reimbursement for the Medicare Part D program, as well as the Medicaid program, broadly.
Frier Levitt Life Sciences Attorneys Jesse C. Dresser, Esq., Steven L. Bennet, Esq. and A.J. Barbarito, Esq. have written an article in the April 6, 2021 issue of Total Pharmacy discussing the law of drug reimbursement. Read the full article here.