Blog

»  Posts By    

Top Legal Issues Impacting Your Pharmacy Every Day

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...

Specialty Pharmacy Indictment Highlights Risks in Prescription Transfers After PBM Network Terminations

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...

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...

Recent Aqua Pharmaceuticals Settlement Highlights Continued Focus on Speaker Programs and State Investigations

Last week, it was announced that the drugmaker formerly known as Aqua Pharmaceuticals, LLC (now Almirall, LLC) has agreed to pay $3.5 million to settle kickback claims stemming from a qui tam whistleblower suit brought by a former sales representative. Among the allegations were that Aqua improperly provided meals, tickets, gift cards and speaking engagements to dermatologists in exchange for prescribing Aqua's products. While providing prescribers items of value (such...