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Prime and Express Scripts’ Joint Venture:  What Pharmacies Need to Know

At the end of 2019, Prime Therapeutics, LLC (“Prime”) announced that it had entered into a three-year supply chain agreement with Express Scripts, Inc. (“ESI”) “to focus on enhancing pharmacy networks and pharmaceutical manufacturer value.”  Prime specifically announced that Prime’s health plans would begin to transition to ESI’s commercial and Medicaid pharmacy networks starting April 1, 2020, noting that there would be no change to claims processing requirements, including BIN/PCNs. ...

Provider Alert: “Non-Renewals” of Pharmacies and Physicians’ Offices Become Increasingly Common

There is a growing trend of plan sponsors and their agents not renewing contracts with pharmacies and physicians.  These “non-renewals” are tantamount to network termination, and are nearly always “without cause”, leaving providers unable to provide services to beneficiaries whose health insurance otherwise covers these services. However, providers have several rights against these terminations, and can take steps to ensure that their contracts are renewed, not subject to termination, or...