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...

Recently, Pharmacy Benefit Managers (PBMs) have been subjecting pharmacies and their credentialing applications to additional scrutiny. In one instance, a major PBM sought to terminate a pharmacy for its failure to report disciplinary action against the Pharmacist-In-Charge's license that occurred over 17 years prior. In another instance, another PBM attempted to terminate a pharmacy for allegedly not updating its ownership information. Frier Levitt was able to assist both pharmacies in...

In January of 2018, Prime Therapeutics announced that it would no longer accept any new Dispensing Physician practices into its pharmacy networks. "Grandfathered" Dispensing Physician practices that were already in Prime’s networks would remain unaffected. However, earlier this year, Prime altered its position and in addition to preventing new Dispensing Physician practices from entering into its networks, Prime began terminating a number of existing Dispensing Physician practices without any stated...

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...

In a growing trend, CVS Caremark (Caremark) has joined the ranks of PBMs to begin offering a mail order network in both commercial and Medicare Part D networks. Caremark has recently contacted a number of pharmacies participating in Caremark retail networks requiring they accept a Mail Order Pharmacy Addendum. This notice to pharmacies Caremark has identified to be operating under a "non-standard retail pharmacy model" based on the volume of...