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Senators Ask OIG to Investigate PBM Industry

After the Senate Finance Committee's hearing (third in a series of hearings), "Drug Pricing in America: for Change," held on April 9, 2019, Senators Chuck Grassley and Ron Wyden wrote a letter to the Department of Health and Human Services' Office of Inspector General (OIG) alerting OIG that "increasing number of reports" raise concerns about how Pharmacy Benefit Managers (PBMs) are operating. In the letter, Senators Grassley and Wyden expressed...

Pharmacy ALERT: PSAO Pharmacy First Sends Notice of GER Deductions

Pharmacy Services Administrative Organization (PSAO) Pharmacy First is sending out a "Notice of GER Deductions" to pharmacies in its network advising that the pharmacy's reimbursements have been running in excess of the contracted Generic Effective Rate (GER) amount. The Notice warns the pharmacy that the monetary sum in excess of the contracted GER amount will be withheld. It is often the case that the pharmacy is without any knowledge of...

Plan Sponsor ALERT: New York Seeks To Eliminate PBM Spread Pricing

On April 1, 2019, New York legislators have passed new regulations eliminating "spread pricing" on prescription drugs within the Medicaid managed care system. Under "spread pricing" arrangements, PBMs bill the Plan Sponsor for the drug dispensed by the pharmacy more than the amount the PBM pays to the pharmacy. The difference is the "spread," which the PBM retains as revenue. Over the last few years, PBMs have been lowering pharmacies'...

Pharmacy ALERT: CVS Caremark Demands Retail Pharmacies Accept Mail Order Pharmacy Addendum

In a growing trend, CVS Caremark (Caremark) has joined the ranks of PBMs to begin offering a mail order network in both commercial and Medicare Part D networks. Caremark has recently contacted a number of pharmacies participating in Caremark retail networks requiring they accept a Mail Order Pharmacy Addendum. This notice to pharmacies Caremark has identified to be operating under a "non-standard retail pharmacy model" based on the volume of...

Frier Levitt Pharmacist Attorney Dae Y. Lee, Pharm.D., Esq. Becomes a Certified Pharmacy Benefits Specialist (CPBS)

Frier Levitt is pleased to announce that Pharmacist Attorney, Dae Y. Lee, Pharm.D., Esq. has become a Certified Pharmacy Benefits Specialist™ (CPBS™). Offered through TransparentRx and accredited by the University of Kentucky School of Pharmacy, the CPBS program is designed to cover relatively complex topics of pharmacy benefit management in order to provide a foundational knowledge required for higher-level evaluation of PBM business operations, fundamentals of PBM pricing, plan design,...