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Ohio Legislators Stand up to Predatory PBM Fees in 340B Drug Pricing Program

Ohio legislators have introduced bipartisan Senate and House bills aimed at curbing excessive fees charged by insurers and Pharmacy Benefit Managers to pharmacies and providers participating in the 340B Drug Pricing Program. The 340B Program, created in 1992 by the federal government, aims to provide certain safety net health providers with funding through a system whereby outpatient drug savings are passed along to the provider. Drug manufacturers participating in Medicaid...

Pharmacy Benefit Managers Contribute to the Growing Rate of Independent Pharmacy Closures, However, Pharmacies Can Fight Back

As another independent pharmacy closed its doors last week in Connecticut, the owner of the pharmacy identified that the rising costs of operations and direct and indirect remuneration (DIR) fees along with the decreasing reimbursement rates each year led to their closure. Unfortunately, this has been the ill-fated result of many independent pharmacy owners throughout the country when Pharmacy Benefit Managers (PBM) are permitted to own the end-retailer, and a...

What is Net Promoter Score and Why Should Your Pharmacy Care?

Pharmacies and physicians that dispense should be aware of Net Promoter Scores (“NPS”). A NPS is a survey metric used by PBMs purportedly to evaluate customer or patient satisfaction. The score is calculated from responses to the question, such as: “How likely is it that you would recommend [pharmacy x] to a friend or colleague?” Patients are asked to answer the question on a scale from 0 to 10. Responses...

PHARMACY ALERT: PBM’s Recouping on Telehealth Prescriptions

Pharmacy Benefit Managers (PBMs) regularly audit independently-owned pharmacies and seek recoupments on allegedly discrepant claims for a number of different bases. Recently, Frier Levitt has seen an uptick in the number of audits whereby PBMs have decided to recoup claims based on allegedly "invalid prescriber-patient relationships." Specifically, PBMs are claiming that the underlying prescriptions are discrepant because of "invalid" telemedicine encounters between the patients and their respective prescribers, creating an...

PHARMACY ALERT: History and Status of Generic Effective Rate

We first reported in late 2018 that Pharmacy Benefit Managers (PBMs) and Pharmacy Services Administrative Organizations (PSAOs) have implemented a new type of post-sale recoupment called Generic Effective Rate (GER) upon their member pharmacies. In particular, CVS Caremark ("Caremark") have been in the forefront, either directly or through its contracted PSAOs, to collect payments made to the pharmacies allegedly in excess of the contracted GER. Caremark started imposing GER liabilities...