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The Impact of COVID-19 on PBM Contracts

Plan Sponsors, ranging from self-insured employers to government entities, have taken steps to relax requirements so that patients have access to healthcare and life saving drugs. However, some PBMs have taken the opportunity to syphon money out of Plan Sponsors, at the expense of both Plans and patients. We will discuss three areas of concern for Plan Sponsors during COVID-19. Price Guaranty Provision. PBM contracts often contain force majeure provisions...

CVS Health Settles for $15.3 Million Over Improperly Dispensing Opioids and Other Controlled Substances

According to a recent Department of Justice (“DOJ”) announcement, CVS Health’s subsidiary, Omnicare, which provides pharmacy services to long-term care facilities, will pay $15.3 million to the United States to resolve allegations that it violated the Controlled Substances Act. Specifically, allegations include that Omnicare processed written prescriptions which included obvious facial deficits, such as not including the prescriber name and DEA number, and that it mishandled “emergency kits.” These “emergency...

Plan Sponsor News June 2020: Helping Large Employers, Union Groups and Self-Insured Companies Understand their Drug Benefit Design

Click here to view our June 2020 issue of Plan Sponsor News!  This publication is designed to help large employers, union groups and self-insured companies understand their drug benefit design.  In this issue, you'll read about: The Impact of COVID-19 on PBM Contracts Key Items in Pharmacy Benefit Manager Contracts Understand the Truth About PBMs and Manufacturer Rebate Revenue Embrace Reverse Auction Procedure and Protect Plan Dollars with Proper Contractual Tools...

N.Y. BlueCross BlueShield Sues Walgreens for “Systematic Prescription Overcharging”

A group of New York BlueCross BlueShield health plans have filed suit against Walgreens, the largest community pharmacy chain, in U.S. District Court for the Northern District of Illinois alleging Walgreens inflated usual and customary (U&C) charges and obfuscated cash pricing information for most of the drugs eligible for its discount program. The lawsuit follows a $269 million settlement on January 19, 2019 for claims brought by the U. S.,...

UPDATE: Many PBMs Have Continued to Add or Extend Relaxations During COVID-19

In an effort made in response to the COVID-19 emergency thus far, as previously discussed in our posts, “What Are the PBMs Doing Amid COVID-19 Crisis: Waivers from Strict Requirements May Exist for Independent Pharmacies,” and “UPDATE: Humana and Prime Therapeutics’ Response to Waivers from Strict Requirements for Independent Pharmacies Amid COVID-19 Crisis,” many Pharmacy Benefit Managers (“PBMs”) have taken further steps to extend their relaxed requirements or provide additional flexibilities...