Recently, Prime Therapeutics (Prime) announced that its member pharmacies should only dispense prescriptions with dosage strengths and routes of administration that are consistent with manufacturer prescribing information. Prime also now further requires that the pharmacies should anticipate providing scientific evidence demonstrating the efficacy and safety of the prescriptions. Such onerous document requests by Pharmacy Benefit Managers (PBMs) have been prevalent with respect to Medicare Part D claims. In fact, it...
November 05, 2019 |
By: Jesse C. Dresser, Esq. We've all heard the examples where failure to notify one state's Board of Pharmacy of disciplinary action imposed by another state's Board of Pharmacy has had a cascading effect, resulting in spiraling and circuitous fines and discipline. However, did you know that failure to provide timely notification of discipline (and other actions) can have PBM implications as well? Many PBM manuals contain sections detailing the obligation to report disciplinary actions,...
September 24, 2019 |
By: Jesse C. Dresser, Esq. https://www.youtube.com/watch?v=MlfmfntpEkQ Legal matters not only impact a pharmacy's operations, but also impact their bottom line. This recorded webinar discusses the top legal issues as they relate to the pharmacy industry today and how these issues correlate to the day-to-day accounting and cash flow management of the pharmacy. It provides a meaningful understanding of the top trends and explains how to plan and prioritize for them in your pharmacy. In this...
September 18, 2019 |
By: Jesse C. Dresser, Esq. The U.S. Attorney's Office for the District of New Jersey recently released a superseding indictment against the owners and operators of several specialty pharmacies, alleging a $99 million fraud scheme. The indictment combined and added to several previous, separate indictments and criminal complaints against three owners of the pharmacies, and the operations manager. While many of the allegations are unsurprising from a healthcare fraud standpoint (e.g., kickbacks to physicians, billing...
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...
