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Five Things Providers Must Know About Express Scripts’ Newly Implemented DIR Program

Specialty pharmacies and physician dispensers will experience a drastic reduction in Medicare net reimbursement rates from Express Scripts, Inc. (ESI) beginning in the plan year 2020. ESI has implemented a DIR Fee program in certain Medicare Part D networks, likely including Cigna following its purchase of ESI. ESI has followed the lead of other major PBMs. Declining net reimbursement rates are the number one Provider concern nationally. Here are the...

Generic Effective Rate (GER): A New Type of Post-Sale Clawback by PBMs

*This blog originally appeared on healthcare.buzz  Post-sale clawbacks by Pharmacy Benefit Managers (PBMs) have become a huge issue for independent pharmacies. Traditionally, these include audit-associated recoupment and performance-based recoupment such as Direct and Indirect Remuneration (DIR) fees that are charged to the pharmacies. Recently, another type of post-sale recoupment has taken the center stage and has caused grave financial harm to the independent pharmacies. PBMs call it Generic Effective Rate...

Plan Sponsor ALERT: PBMs Should Be Held Accountable for Opioid Crisis

It is no secret that the opioid crisis has caused devastating impacts upon patients and their loved ones as well as the overall healthcare industry. Since the inception of the crisis, public Plan Sponsors including state agencies and municipalities, have brought countless claims against the opioid manufacturers, distributors, and wholesalers. However, until recently, plaintiffs have failed to apprehend the critical role played by Pharmacy Benefit Managers (PBMs) in the on-going...

What Pharmacies Need to Know: Appearing in Front of a State Board of Pharmacy

https://www.youtube.com/watch?v=QlfuFNe3wYA&feature=youtu.be In this video, attorneys Jonathan E. Levitt, Esq. and Lucas W. Morgan, Esq. discuss what pharmacies should be aware of when appearing in front of a State Board of Pharmacy. Contact Frier Levitt today to speak to an attorney.

Minnesota Enacts New PBM Law: Notice and Comment Period for Proposed Regulations Open to the Public

On May 20, 2019, Minnesota Governor Tim Walz signed the Minnesota Pharmacy Benefit Manager Licensure and Regulation Act into law. Among the various new restrictions and responsibilities placed upon Pharmacy Benefit Managers (PBMs) acting within the State are the following: PBMs must be licensed to operate within the State by the Commissioner of Commerce (Commissioner) PBMs are required to maintain "adequate" networks, and those networks must be exclusive of mail-order pharmacies....