In January of 2018, Prime Therapeutics announced that it would no longer accept any new Dispensing Physician practices into its pharmacy networks. “Grandfathered” Dispensing Physician practices that were already in Prime’s networks would remain unaffected.
However, earlier this year, Prime altered its position and in addition to preventing new Dispensing Physician practices from entering into its networks, Prime began terminating a number of existing Dispensing Physician practices without any stated basis. More recently, Prime has engaged in widespread efforts and has issued notices of termination to several more, if not all, of its Dispensing Physician practices. The sole basis of such decision is that Prime “no longer accepts dispensing physicians in its pharmacy networks.” Prime’s decision to prevent any Dispensing Physician practices from participating in its networks without any stated cause compromises the ability to foster value-based care and an integrated patient care model.
Dispensing Physician practices who have been terminated from Prime’s networks or have been denied admission should understand they have certain protections under their agreements with Prime and under applicable federal and state laws. Practices should leverage these legal tools to challenge Prime’s decision.
Contact Frier Levitt today to speak to an attorney on next steps available to your practice.