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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...

Pharmacy ALERT: Aetna Sends Termination Notices to Medicare Part D Network Pharmacies Based on Billing for Lidocaine Creams and Other Topical Treatments

Aetna has sent out notices of termination to Medicare Part D Network pharmacies based on a recent guidance from the Centers for Medicare and Medicaid Services (CMS) and the Office of the Inspector General (OIG). In the guidance, CMS and the OIG do not recommend termination as the response to any indicia of these billing practices. With respect to compounding and specialty pharmacies, CMS specifically advises that "pharmacies that specialize...

Frier Levitt Successfully Reverses Termination from PBM Network for a New York Pharmacy

A New York Pharmacy's network termination by a major PBM for a was recently rescinded as the result of emergent intervention from Frier Levitt. The PBM was alleging discrepancies in the pharmacy's credentialing document and, although the pharmacy's principal never made any intentional misrepresentations, the PBM nevertheless terminated the pharmacy and plan sponsors sent out notices to the pharmacy's patients. Frier Levitt assisted at all stages of the dispute. Frier...

Drug Wholesaler’s Criminal Prosecution Provides Case-Study for Compliance Do’s and Don’ts

Rochester Drug Cooperative (RDC) recently entered into a plea with the federal government in which it admitted wrongdoing and agreed to pay $20 million in fines, receiving a prosecution deferral subject to a three-year monitoring period by an independent compliance official. Moreover, the government brought criminal charges against former CEO Laurence F. Doud III and William Pietruszewski, the former chief of compliance. Pietruszewski has reportedly entered a plea and is...

The End of Chevron Deference Could Foretell the Beginning of Equal Access to Care Under Medicaid

One cannot move in legal circles without hearing at least some discussion of the SCOTUS' position on the administrative state. With a now-entrenched conservative majority and at least two or three of those justices expressing doggedly anti-regulation views, many are asking if one of the venerable pillars of the administrative state—the doctrine known as "Chevron deference"—will ultimately be abrogated by the Court. The name "Chevron deference" is derived from the...