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Frier Levitt Secures Reversal of Pharmacy Termination from Major Plan Sponsor

Frier Levitt recently represented a New York pharmacy that had suffered a termination without adequate notice directly from a major plan sponsor. The plan stated the termination was in light of recent guidance from CMS and the Office of Inspector General of the Department of Health and Human Services (OIG) related to alleged questionable billing practices related to certain lidocaine creams and topical treatments, and it sought to identify and...

Generic Effective Rate (GER): A New Type of Post-Sale Clawback by PBMs

*This blog originally appeared on healthcare.buzz  Post-sale clawbacks by Pharmacy Benefit Managers (PBMs) have become a huge issue for independent pharmacies. Traditionally, these include audit-associated recoupment and performance-based recoupment such as Direct and Indirect Remuneration (DIR) fees that are charged to the pharmacies. Recently, another type of post-sale recoupment has taken the center stage and has caused grave financial harm to the independent pharmacies. PBMs call it Generic Effective Rate...

Minnesota Enacts New PBM Law: Notice and Comment Period for Proposed Regulations Open to the Public

On May 20, 2019, Minnesota Governor Tim Walz signed the Minnesota Pharmacy Benefit Manager Licensure and Regulation Act into law. Among the various new restrictions and responsibilities placed upon Pharmacy Benefit Managers (PBMs) acting within the State are the following: PBMs must be licensed to operate within the State by the Commissioner of Commerce (Commissioner) PBMs are required to maintain "adequate" networks, and those networks must be exclusive of mail-order pharmacies....

Frier Levitt Negotiates Access to PBM Network for Previously Denied Pharmacy

Frier Levitt recently negotiated a contract with a PBM network for a pharmacy that had been denied entry on several previous occasions. The pharmacy had applied for a contract numerous times and was denied for various reasons for more than a year, eventually seeking legal assistance from Frier Levitt. Frier Levitt intervened and through application of in-depth knowledge of legal requirements and the PBM application process, assisted the pharmacy to...

Pharmaceutical Wholesaler ALERT: Manufacturer Targeting Wholesalers for Allegedly Exploiting Returns Process

A major pharmaceuticals manufacturer may be targeting wholesalers and other distributors who allegedly exploited the manufacturer's returns process. The manufacturer appears to be alleging that distributors fraudulently represented the source of certain drugs, or that they falsely represented the circumstances of their purchase of the drugs, in order to allegedly induce the manufacturer or their agent to accept them through its return goods program and pay out reimbursements in accordance...
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