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Frier Levitt Wins Preliminary Injunction Against PBM for New York Pharmacy

Frier Levitt recently commenced an emergency arbitration against a PBM that had scheduled a termination against a pharmacy client. The PBM had subjected the pharmacy to an audit and had terminated the pharmacy based upon the results of the audit. The pharmacy argued it had presented the PBM with ample evidence to refute the audit results and, after the hearing on the preliminary injunction, the arbitrator found the pharmacy had...

New Jersey Law Grants Rights to Pharmacies Against PBM Post-Adjudication Fees and Mailing Prohibitions

On December 19, 2019, NJ Governor, Phil Murphy, signed into law an important new bill regulating PBMs, effective on March 18, 2020. The bill, A3717, passed with unanimous support in both legislative houses, amends the State’s current PBM regulations and outlaws post-adjudication fees by PBMs, such that: "After the date of receipt of a clean claim for payment made by a pharmacy, a pharmacy benefits manager shall not retroactively reduce...

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....