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Frier Levitt Recovers Over $300K in GER Withholdings From PSAO

Frier Levitt recently recovered over $300K held in reserve from a Pharmacy Services Administrative Organization (PSAO), which withheld the funds to due to Generic Effective Rate (GER) adjustments for the calendar year 2018. This is another major win for an independent pharmacy that suffered grave financial harm. Many pharmacies have begun receiving notices of GER adjustments, ranging from thousands to millions of dollars, without having an opportunity to examine any...

Pharmacy ALERT: PSAO EPIC Pharmacies’ Notice of GER Deductions for the Calendar Year 2018

Pharmacy Services Administrative Organization (PSAO) EPIC Pharmacies, Inc. (EPIC), has been sending out a "Notice of GER Deductions" to pharmacies since last November indicating that the pharmacy's reimbursements have been running in excess of the contracted Generic Effective Rate (GER) amount for the calendar year 2018. Many pharmacies were unaware about the GER until they received the Notice of GER Deductions and were subjected to GER withholdings.  Frier Levitt has...

UnitedHealthcare Wrongly Categorized Cancer Treatment as Experimental to Avoid Coverage

Recently, a class action against UnitedHealthcare was filed in the United States District Court for the Southern District of Florida. The class members in the lawsuit allege that UnitedHealth wrongly categorized proton beam radiation therapy as an experimental or investigational treatment for prostate cancer to avoid providing coverage. This suit took a drastic turn when the presiding Judge Robert N. Scola Jr. recused himself because of his personal view on...

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. ...