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...
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...
This week, the state of New Jersey joined the long list of States to file suit against the principle members of the Sackler Family, owners of Purdue Pharma. While Purdue Pharma and the Sackler Family may have become poster children for greed in the face of the opioid epidemic, leading many states to commence politically-popular legal proceedings, this case demonstrates a growing trend of state attorneys' general offices bringing independent...
According to a report by the Michigan Pharmacists Association and 3 Axis Advisors, Pharmacy Benefit Managers (PBMs) overcharged the state’s Medicaid Program by at least $64 million through spread pricing. The report collected data from 451 community pharmacies across Michigan, representing nearly 20% of the 2,356 retail/community pharmacies in the state to analyze PBM spread pricing – the difference between what a PBM pays a pharmacy for a medication and...
https://www.youtube.com/watch?v=RgWy4EZpWIY&feature=youtu.be In a world where PBMs also operate their own in-house specialty pharmacies, the incentive to reduce competition has never been stronger. PBMs have used a variety of reasons to justify network termination, many of which are easily avoidable. But to do so requires knowledge by pharmacies, as well as swift and careful action when addressing audits, investigations and credentialing applications. In this recorded webinar, Jesse C. Dresser, Esq. attorney...
