A bipartisan piece of legislation aimed at regulating pharmacy benefit managers (PBMs) in the State of Texas unanimously passed the House and Senate in Texas. Specifically, House Bill (HB) 1763 previously passed the Texas House by a vote of 147-0... Read More
On April 12, 2021, Senator Kolkhorst, along with a bipartisan group of cosponsors, introduced SB 2195, a Bill that prohibits Pharmacy Benefit Managers (“PBMs”) operating in Texas from assessing against pharmacies a variety of different types of... Read More
Pharmacy Benefit Managers (PBMs) routinely request pharmacies to submit credentialing when seeking admission into their networks, and require re-credentialing applications to be submitted two to three years after the pharmacies’ admission. The... Read More
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
In a recent trend, pharmacies have begun receiving notices of termination not for billing errors or audit findings, but for claims inactivity. Specifically, several Pharmacy Benefit Managers, or PBMs, have been terminating pharmacies solely because... Read More
Many pharmacies are faced with PBM audits resulting in final audit finding recoupments which can range from very large to very small dollar amounts. Many times, when the recoupment is smaller in sum, pharmacies may be inclined to forgo contesting... Read More
In a recent trend, the Blue Cross and Blue Shield Federal Employee Program (“FEP”), whose pharmacy benefits are administered by CVS Caremark, has been seeking an increasing amount of terminations of network pharmacy providers. Specifically, the... Read More
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
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
Frier Levitt successfully reversed a five year wait for readmission for an independent pharmacy into one of the largest Pharmacy Benefit Managers (“PBM”) pharmacy networks. More specifically, the pharmacy was terminated by the PBM in 2017 for... Read More
