Blog

NYC Transit Authority sues Express Scripts for Failing to Effectively Manage its Prescription Drug Benefit Plan

A recent lawsuit filed by the New York City Transit Authority (NYCTA) raises important considerations for plan sponsors and agencies, such as the NYCTA, that retain the services of Pharmacy Benefits Managers (PBMs). On May 16, 2019, the NYCTA sued Express Scripts in New York state court alleging six counts for breach of contract. The NYCTA alleges that since retaining Express Scripts to manage its prescription drug benefit plan, "the...

Pharmacy ALERT: PSAO EPIC Pharmacies’ Notice of GER Deductions for the Calendar Year 2018

Pharmacy Services Administrative Organization (PSAO) EPIC Pharmacies, Inc. (EPIC), has been sending out a "Notice of GER Deductions" to pharmacies since last November indicating that the pharmacy's reimbursements have been running in excess of the contracted Generic Effective Rate (GER) amount for the calendar year 2018. Many pharmacies were unaware about the GER until they received the Notice of GER Deductions and were subjected to GER withholdings.  Frier Levitt has...

Pharmacy ALERT: Prime Therapeutics Heightens Investigative Efforts Against Pharmacies with Enhanced Oversight Addendums

Prime Therapeutics is notorious for taking an aggressive stance against its network pharmacies regarding enhanced credentialing criteria.  Over the past year, we have reported numerous instances whereby Prime has sought to terminate pharmacies for alleged credential non-compliance.  In recent weeks, Prime has taken steps to heighten its investigation into pharmacies that have signed Enhanced Oversight Addendums (EOA). These EOAs were offered to pharmacies participating in Prime’s networks in response to...

How to Respond to Document Requests, Audits & Overpayment Demands Webinar Recording

https://youtu.be/QY7nwgQ1IlY Healthcare is one of the most highly regulated industries in the country. When physicians and practices receive document requests, audit notices, and overpayment demands, knowing what to expect and how to react can help save money, protect your professional license and avoid litigation. This webinar will take you through the process of the what to do when you or your practice receives a request or demand from a government...

New DOJ False Claims Act Guidelines: Credit for Disclosure, Cooperation and Remediation

In May, the US Department of Justice (DOJ) issued revised guidelines regarding "taking disclosure, cooperation and remediation into account in False Claims Act (FCA) matters." These guidelines highlight the federal government’s interest in the voluntary disclosure of FCA violations by entities and individuals. The DOJ notes that "entities and individuals that make proactive, timely, and voluntary self-disclosure" to the government may be eligible to receive credit during the resolution of...