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Surprise Cuts in Medicaid Reimbursements and the Impact on Independent Pharmacies

Pharmacy Benefit Managers (PBMs) use many different tactics to increase their revenue, and spread pricing has long been a common way to generate incremental revenue from each transaction. This has become a state-wide problem in Kentucky, especially for the Department for Medicaid Services (DMS). Pharmacy costs have become the fastest growing budget items in the Kentucky Medicaid budget. In the calendar year 2018, PBMs reported being paid $957.7 million from...

Frier Levitt Successfully Reverses PBM Network Termination

Frier Levitt was recently successful in reversing a Florida pharmacy’s network termination by a major PBM. The PBM had sent a Notice of Termination alleging that the pharmacy failed to comply with terms and conditions set forth by PBM Agreement and Provider Manual by waiving copays and processing unwanted refills. Notably concerning was that the pharmacy did not receive any notice of audit prior to receiving the Notice of Termination. ...

Manufacturer ALERT: Vitamin Supplements May Contain Toxins

An Illinois man alleges that he was exposed to toxins, including arsenic, cadmium, and lead, which were in The Vitamin Shoppe's daily vitamin supplement. The complaint was filed by Harvey Mahler in the Circuit Court of Cook County but is now pending in the United States District Court for the Northern District of Illinois.  The lawsuit presents claims against the manufacturer and the distributor, The Vitamin Shoppe, indicating that the...

PBMs Overcharged Michigan Medicaid by $64 Million

According to a report by the Michigan Pharmacists Association and 3 Axis Advisors, Pharmacy Benefit Managers (PBMs) overcharged the state’s Medicaid Program by at least $64 million through spread pricing. The report collected data from 451 community pharmacies across Michigan, representing nearly 20% of the 2,356 retail/community pharmacies in the state to analyze PBM spread pricing – the difference between what a PBM pays a pharmacy for a medication and...

The Growing Trend of PBM Track-And-Trace Audits

Recently, Pharmacy Benefit Managers (PBMs) have been requesting pharmacies to provide documentation in compliance with Drug Supply Chain and Security Act (DSCSA), better known as “track-and-trace." DSCSA was enacted as part of the Drug Quality and Security Act of 2013 and outlines steps for the drug chain participants to implement a system that tracks a drug at the unit-level throughout the drug supply chain. At this juncture, the United States...