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PHARMACY ALERT: Recent Trend of PBM Nonpayment Issue with Independent Pharmacies

Frier Levitt has noticed a recent uptick in pharmacies experiencing issues with not consistently receiving payments from certain PBMs – including OptumRx – on clean claims. This could involve untimely payments, unreconciled payments or payments that are missing altogether. If your pharmacy is facing financial harm as a result of OptumRx or other PBMs’ failure to make timely payments, you may only have a short time to dispute them. In...

ESI Recoupment Letters: Absence of Prescriber-Patient Relationship

At the request of the Defense Health Agency (“DHA”), Express Scripts, Inc. (“ESI”) has begun sending letters to some of the pharmacies within its network recouping on claims that had been submitted to TRICARE. This recent batch of letters is particularly notable because they focus on the results of DHA investigations – as distinct from an audit – a particularly powerful tool that enables ESI to evaluate and review claims...

Toolkit for Pharmacies Negatively Impacted by the Coronavirus Pandemic

Much of America is now entering the third week of social distancing, and with the President’s decision to extend Coronavirus mitigation guidelines through the end of April, businesses are bracing for continued interruption. Providers across the healthcare continuum – including pharmacies – have already begun to feel financial constraints, and ask, “What can be done?” Fortunately, this week also heralded the passage of the Coronavirus Aid, Relief, and Economic Security...

UPDATE: Humana and Prime Therapeutics’ Response to Waivers from Strict Requirements for Independent Pharmacies Amid COVID-19 Crisis

As previously discussed in our post, “What Are the PBMs Doing Amid COVID-19 Crisis: Waivers from Strict Requirements May Exist for Independent Pharmacies,” many healthcare companies alike are taking further actions to ensure that patients have access to the critical healthcare services they need and to help diminish the unnecessary risks of exposure and contact to those outside of close family members or cohabitants in light of the COVID-19 outbreak....

Manufacturer ALERT: Recent FDA Guidance Accelerates Availability of COVID-19 Testing

FDA Relaxes Requirements for COVID-19 Testing In early February, the Secretary of Health and Human Services determined that the respiratory disease, called Coronavirus (COVID-19), caused by the virus SARS-CoV2, is a public health emergency justifying the authorization of emergency use of in vitro diagnostic tests for cases in the US. To achieve rapid and widespread testing for COVID-19, the Food and Drug Administration (FDA) then relaxed its regulations on the...