Physician groups contracting with government-regulated health plans such as Medicare-Advantage Organizations, Medicaid Managed Care Organizations, or ACA Marketplace Individual/Small Group Issuers often enter into capitated payment models with... Read More
Blogs & Articles | Healthcare | Healthcare Law | Healthcare Litigation | Medicare and Insurance Audits | Medicare, Medicaid, and Other Commercial Payor Audits & Appeals | Recent Results | Recent Successes | Value Based Care | Value Based Care

Frier Levitt successfully lifted a payment suspension imposed by a major Pharmacy Benefit Manager ("PBM") upon an independent pharmacy based in New York. The PBM effectuated the payment suspension shortly after conducting an audit but prior to... Read More
Blogs & Articles | Defending Pharmacies in PBM Audits | Life Sciences | Pharmacy Law | Recent Results | Recent Successes | Specialty Pharmacies

Frier Levitt recently assisted a New Jersey-based specialty pharmacy audited by a large health plan and its PBM which had placed over $500,000 at issue through various audit discrepancies, including alleged invalid prescriptions, insufficient proof... Read More
Blogs & Articles | Defending Pharmacies in PBM Audits | Life Sciences | Pharmacy Law | Recent Results | Recent Successes | Specialty Pharmacies

Frier Levitt recently assisted a New York-based independent pharmacy that was placed under temporary payment suspension by a national Pharmacy Benefit Manager (“PBM”).  Notably concerning, the temporary suspension was effectuated while the... Read More
Blogs & Articles | Community, Retail Pharmacies | Defending Pharmacies in PBM Audits | Pharmacy Law | Recent Results | Recent Successes

Frier Levitt was recently successful in reversing a Midwest pharmacy’s enrollment application denial by a major Pharmacy Benefit Manager (“PBM”). The PBM denied the pharmacy’s enrollment application alleging that the pharmacy was previously... Read More
Blogs & Articles | Community, Retail Pharmacies | Life Sciences | Payor Network Access and Defense of Network Terminations | Pharmacy Law | Recent Results | Recent Successes

Frier Levitt recently assisted an independent pharmacy based in New York that was being audited by a national pharmacy benefit manager (PBM). During the course of the audit, the PBM alleged various audit discrepancies including drug invoice... Read More
Blogs & Articles | Community, Retail Pharmacies | Defending Pharmacies in PBM Audits | Life Sciences | Pharmacy Law | Recent Results | Recent Successes

Frier Levitt recently helped a Texas-based independent pharmacy that was facing an audit conducted by a national PBM.  The PBM alleged various discrepancies including drug invoice shortages.  The discrepancies amounted to significant audit fines.... Read More
Blogs & Articles | Community, Retail Pharmacies | Defending Pharmacies in PBM Audits | Life Sciences | Pharmacy Law | Recent Results

Frier Levitt successfully reverses a PBM network termination on behalf of an Illinois pharmacy.  The PBM, which is wholly owned by a publicly traded company, conducted an onsite inspection of the Pharmacy and identified a number of expired drug... Read More
Blogs & Articles | Community, Retail Pharmacies | Defending Pharmacies in PBM Audits | Life Sciences | Payor Network Access and Defense of Network Terminations | Pharmacy Law | Recent Results

Frier Levitt recently obtained a $6.25 Million settlement against a Pharmacy Benefits Manager(“PBM”) on behalf of its Plan Sponsor client (“Plan”). The Plan contracted with the PBM to administer its prescription drug program, and to... Read More
Blogs & Articles | Life Sciences | Pharmacy Law | Plan Sponsor PBM Contract Services | Recent Results | Recent Successes

Pharmacies often undergo changes to their businesses and operations, primarily to adapt to the changing landscape of providing pharmacy services. These changes are the natural evolution of a business over time.  However, in undergoing these... Read More
Blogs & Articles | Community, Retail Pharmacies | Defending Pharmacies in PBM Audits | Life Sciences | Payor Network Access and Defense of Network Terminations | Recent Results