According to recent statistics released by the Department of Justice (DOJ), federal government enforcement actions targeting the health care and pharmaceutical industries have risen over the past year by about 5%. In 2019, the DOJ brought in over $3 billion in judgments and settlements under the False Claims Act (FCA), with $2.6 billion stemming from health care and life sciences companies such as hospitals, drug manufacturers and pharmacies. In addition,...
The State of Ohio has become one of the many states that have fallen victim to PBMs' abusive revenue tactics, as detailed in an audit report finding that the state's PBMs — OptumRx and Caremark — charged the state a spread of 31% on generic drugs. As a result, the state was charged $224 million, at the expense of the taxpayers, more than what these PBMs paid pharmacy providers in...
December 10, 2019 |
By: Jesse C. Dresser, Esq. There is a growing trend of pharmacies that are being terminated from pharmacy networks by Pharmacy Benefit Managers (PBMs) due to the pharmacy's affiliation with providers who have been previously terminated from the PBM's pharmacy network. PBMs are targeting pharmacies that have relationships with terminated individuals or pharmacies. This means that your pharmacy could be subject to termination if it has common ownership, hired employees, maintains officers, or directors, who...
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,...
