Blog

New York Governor Vetoes PBM Bill

To the dismay of consumers and independent pharmacists, Governor Cuomo recently vetoed legislation passed by the state Legislature in June, designed to license and oversee pharmacy benefit managers ("PBMs"). The Bill, S. 6531, was endorsed by the Senate Investigations and Government Operations Committee, which found that PBM practices generate more revenue for them at the expense of patients and pharmacies, most notably through spread pricing. Licensing provisions under the new...

It is Time to Rethink Hospital-Physician Relationships

According to the AMA, employed physicians now outnumber private practice physicians for the first time. Does this mean private practice physicians will eventually be the rare exception rather than the rule? Is there still a significant role for physician-owned private practices? Relatedly, as hospitals consolidate to fight off the accelerating trend towards outpatient care, which is increasingly being controlled by health insurers (e.g., Optum, which directly or indirectly employs tens-of-thousands...

Pharmacy ALERT: CVS Caremark Releases Dispensing Limitations to be Effective January 2020

Over the past year, CVS Caremark began taking a series of actions against pharmacies who were dispensing "aberrant quantities" of medications within a particular therapeutic category. Despite never defining "aberrant quantities," CVS Caremark continued to place pharmacies whose dispensing practices were flagged for this reason under adjudication and payment suspension and/or subjected them to a Mail Order Addendum for being a "non-standard retail pharmacy." According to CVS Caremark, pharmacies that...

Plan Sponsor ALERT: Ohio Continues Its Fight Against Abusive PBM Practices

The State of Ohio has become one of the many states that have fallen victim to PBMs' abusive revenue tactics, as detailed in an audit report finding that the state's PBMs — OptumRx and Caremark — charged the state a spread of 31% on generic drugs. As a result, the state was charged $224 million, at the expense of the taxpayers, more than what these PBMs paid pharmacy providers in...

Frier Levitt Successfully Defends Three Physicians Facing Board Matters

Frier Levitt successfully represented three physicians facing actions before the Board of Medical Examiners. In one matter, a physician faced patient abandonment allegation when the patient complained about post-care prescribing practices. After preparing a thorough narrative response that detailed a physician's duties to a patient and the appropriateness of the prescribing and actions, the Board closed the matter to be kept in its confidential files. In another matter, a physician...