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2019 Industry Outlook: What State Pharmacy Associations and Pharmacy Stakeholders Need to Know

With the November elections looming, the policy environment for pharmacy issues hangs in the balance. Who will control the halls of Congress as well as the state legislature will be key in determining the pace of pharmacy legislation. Over the last several months we have seen several positive developments for pharmacy, including clawback legislation; media pressure on PBM transparency; and other industry groups, such as the National Council of Insurance...

The California Insurance Commissioner’s Suit Against AbbVie Highlights Lurking Risks Under State Insurance Fraud Prevention Acts

Earlier this week, the California Insurance Commissioner filed a wide-ranging lawsuit against AbbVie, alleging classic illegal kickbacks to physicians as well as an intricate network of "nurse ambassadors" designed to improperly boost prescriptions for Humira, and seeking over $1.2 billion in damages.  Apart from representing a growing scrutiny on pharmaceutical manufacturers and other ancillary providers supplying nursing services allegedly in an effort to supplant the role of the prescribing physician,...

“Nurse Ambassadors” and California’s Suit Against AbbVie: The Growing Scrutiny of “White Coat Marketing”

Earlier this week, the California Insurance Commissioner filed a wide-ranging lawsuit against AbbVie, the maker of Humira, seeking over $1.2 billion in damages.  In addition to allegations of run-of-the-mill kickbacks to physicians, the lawsuit alleged an intricate network of "nurse ambassadors" designed to improperly boost prescriptions for Humira. This lawsuit, which was interestingly brought under California"s Insurance Frauds Prevention Act as part of a growing trend of State Insurance Commissioners...

The PillPack-Amazon Deal and the Importance of Developing a Strategic Plan for Compliance & Growth

It was recently announced that Amazon will be acquiring the online pharmacy, PillPack, for approximately $1 billion, with each of the founders receiving approximately $100 million each. PillPack's rise and success is one that all pharmacy owners strive for and hope to achieve. What can be learned from PillPack's success story is that in order to reach these goals, pharmacies need to have clear strategic and operational plans, to account...

PBMs Targeting Manufacturer Coupons and Copay Assistance in Pharmacy Audits

PBMs have increasingly begun targeting the usage of manufacturer sponsored coupon programs and copayment assistance programs in both desktop and on-site audits of pharmacies. As a result of these audits, PBMs are alleging discrepancy findings, and recouping money from pharmacies, based on a number of different factors, including, but not limited to, the usage of a coupon on a non-FDA approved drug. Of course, there are certain limitations on when...