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NADAC Pricing and Aggressive PBM Prior Authorization Tactics: How Specialty Pharmacies Can Respond

Nearly every day, independent specialty pharmacies face industry changes that threaten their businesses. This year, two changes have been especially impacting – the implementation of the NADAC pricing benchmark and enhanced and aggressive prior authorization protocols and policies implemented by PBMs.

Unfortunately, the implementation of the National Average Drug Acquisition Cost (NADAC) benchmark has been devastating to some pharmacies, which are often reimbursed at or below acquisition cost. Similarly, independent pharmacies have witnessed enhanced prior authorization review and processing tactics employed by PBMs, which often drive patients toward PBM-owned pharmacies.

In this recorded webinar, attorneys Steven L. Bennet, Esq., and Robert R. Granzen, Esq., demonstrate how your pharmacy can utilize legal avenues to challenge unlawful prior authorization tactics as well as unreasonable Medicaid reimbursement rates.

This presentation will help you:

  • Understand the origin, implementation, and effects of the NADAC pricing benchmark
  • Understand and identify aggressive prior authorization tactics utilized by PBMs
  • Interpret related laws and regulations aimed at addressing both NADAC pricing and unlawful prior authorization policies
  • Learn what steps your pharmacy should take to combat unreasonable NADAC pricing and egregious prior authorization tactics

If your pharmacy is experiencing issues with NADAC pricing or prior authorizations, contact Frier Levitt to speak to an attorney.

This webinar is presented through a partnership with Mediware.