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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...

Plan Sponsor ALERT: PBMs Should Be Held Accountable for Opioid Crisis

It is no secret that the opioid crisis has caused devastating impacts upon patients and their loved ones as well as the overall healthcare industry. Since the inception of the crisis, public Plan Sponsors including state agencies and municipalities, have brought countless claims against the opioid manufacturers, distributors, and wholesalers. However, until recently, plaintiffs have failed to apprehend the critical role played by Pharmacy Benefit Managers (PBMs) in the on-going...

Webinar Recording: How Will USP <800> Impact Your Business

With USP <800> Hazardous Drugs soon to be released, it is important for retail and compounding pharmacies to know how it will impact them and their businesses. In this recorded webinar, attorney John E. Morrone, Esq., and attorney-pharmacist Dae Y. Lee, Pharm.D., Esq., CPBS, provide an overview of USP <800>, including: The background and history on why USP <800> was created Regulation and enforcement of USP <800> States that have...

Plan Sponsor ALERT: Beware of Rebate Aggregators

Plan Sponsors should be aware of a few recent developments that lead to higher net gross and net drug prices. First, the White House recently withdrew a Notice of Proposed Rule Making (NPRM) that would have altered the entire drug marketplace. The NPRM would have eliminated the "Safe Harbor" that permits Pharmacy Benefit Managers (PBMs) to legally extract billions of dollars in "rebate" from Manufacturers in exchange for securing drugs...

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...