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New Jersey’s False Claims Act Suit Against Sackler Family Highlights Growing Trend of State-Level Enforcement, Even at an Individual Level

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...

PBMs Overcharged Michigan Medicaid by $64 Million

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...

The Ins and Outs of PBMs Webinar Recording

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...

Pharmacy ALERT: Amending Rate Schedules in the Middle of a Contract Term

It has been widely reported that Express Scripts has recently issued rate amendments to its Pharmacy Provider Contracts. These purported rate amendments in many instances come on the heels of multiyear contracts that were executed just a few months ago, sometimes after strenuous back and forth negotiating between the pharmacy and the PBM. Moreover, these rates are set to become effective in the very near term, smack dab in the middle of...

DOJ Position on Off-Label Promotion: What’s Changed and What’s the Same

It is well known that the U.S. Food and Drug Administration (FDA) has long taken the position that a medical device or drug manufacturer who promotes any unapproved uses of FDA-approved devices/drugs is in violation of the Federal Food, Drug, and Cosmetic Act (FDCA). The FDA has asserted that off-label promotion leads to misbranding of the product and circumvention of the regulatory approval process that is taken to ensure product...