With the start of 2023, an amendment to Tennessee Legislation requiring that Pharmacy Benefit Managers (“PBMs”) reimburse Tennessee Pharmacies at least the actual cost of the drug, or align with Tennessee Medicaid reimbursement rates, has taken... Read More
Frier Levitt recently assisted a California-based independent pharmacy that faced an audit from a major pharmacy benefit manager (“PBM”) by successfully challenging the audit findings and reversing 100% of the purported discrepancies. During... Read More
Pharmacy benefits manager (PBM) Caremark has now placed Trimester 1 Reports for year 2022 in the Caremark Provider Portal. Caremark provides its summaries of Direct and Indirect Remuneration (DIR) Fees paid by participating pharmacy providers for... Read More
Frier Levitt recently received an impressive $3.6 million arbitration award against Caremark and SilverScript on behalf of a specialty pharmacy client, Mission Wellness, arising from improper DIR Fees. Despite repressive "gag clauses" imposed by... Read More
On May 9, 2022, the Centers for Medicare and Medicaid Services (CMS) released a Final Rule (Final Rule) entitled, “Contract Year 2023 Policy and Technical Changes to the Medicare Advantage and Medicare Prescription Drug Benefit Programs.” ... Read More
Last week, the FTC announced an investigation of six large PBMs in the U.S., sending orders for information and records on business practices. The study will focus on a series of practices used by PBMs and their role in the drug system. The agency... Read More
On Monday, June 6, 2022, the Federal Trade Commission (FTC) voted unanimously to approve a “6(b)” study into the anti-competitive and abusive practices of Pharmacy Benefits Managers (PBMs), a move that has the potential to lead to significant... Read More
Multiple states across the country have recently taken action and enacted new legislation to regulate Pharmacy Benefit Managers (“PBMs”). New York is no exception. Earlier in 2022, New York enacted comprehensive laws governing PBMs. More... Read More
On April 14, 2022, the Federal Trade Commission (FTC) and Department of Justice (DOJ) held a public forum to hear from stakeholders about the effects of mergers within the health care industry and the effects of consolidation on healthcare workers,... Read More
Pharmacy Benefits Managers (PBMs) often make changes to their contracts with pharmacies through notice alone that does not require a signature from the pharmacy. At least one PBM recently issued such a notice to pharmacies regarding a new Medicare... Read More
