Pharmacy Benefits Managers (PBMs) often make changes to their contracts with pharmacies through notice alone that does not require a signature from the pharmacy. At least one PBM recently issued such a notice to pharmacies regarding a new Medicare Part D (Part D) performance network contract to be implemented in 2023.
Pharmacies should be on alert for these notices and should understand the impact of any changes. The new network seeks to account for the new Centers for Medicare and Medicaid Services (CMS) Proposed Part D Rule (Proposed Rule), which CMS introduced on January 12, 2022, and for which the comment period recently closed. We previously discussed the Proposed Rule, which contains a provision that, if enacted, will make it unprofitable for most plans to impose DIR fees. However, nothing in the Proposed Rule requires plans or their PBMs to offer reasonable reimbursement, or to offer performance incentives that are relevant to a particular pharmacy, like specialty pharmacies. This new performance network confirms the fear that PBMs will impose new Programs that continue the abuses of low reimbursement and irrelevant performance metrics.
This new performance network imposes a new kind of fee on all participating providers. The network also offers reimbursement that pharmacies will need to strongly consider, and pharmacies should consider reaching out to Frier Levitt to discuss these new terms and conditions as soon as possible.
How Frier Levitt Can Help.
Frier Levitt is one of the nation’s leading law firms representing pharmacies in contractual and other disputes against PBMs, and our experienced lawyers understand and can provide unparalleled guidance for pharmacies seeking to understand DIR and other Part D Programs, and the pharmacies’ rights under the law. Call Frier Levitt today to learn more about your pharmacy’s Part D contracts.
