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PBM Network Termination Amid COVID-19 Outbreak

Pharmacy Benefit Managers (“PBMs”) continue to put independent pharmacies under scrutiny and terminate them from PBM Networks amid the coronavirus outbreak (“COVID-19”).  PBM Network termination is especially concerning at this time given the national economic and healthcare crisis brought by COVID-19.  Meanwhile, Federal and State Agencies have issued relaxed guidelines for healthcare providers including pharmacies to ensure patient access to healthcare and to mitigate further exacerbation of the outbreak. As...

Let’s Talk: COVID-19 and Healthcare Providers Ability to Provide Care

https://youtu.be/hSnWv8Wz3js In response to the recent COVID-19 outbreak and its impact on providers Jonathan Levitt and Jesse Dresser have created a series of videos talking about some of the issues healthcare and pharmacy clients are facing and ways that they can be proactive. During this crisis we all need to come together and help each other and our attorneys are committed to ensuring that our clients, many of whom are...

PROVIDER ALERT: CMS Issues Guidance to Ensure Patient Access Amid COVID-19

The Center for Medicare & Medicaid Services (CMS) released a moratorium on March 10, 2020 directing Medicare Advantage Organizations (MAOs), Medicare Part D Sponsors (Sponsors), Medicare-Medicaid Plans (Plans), and consequently, pharmacy providers to remove certain barriers that could hinder patients from receiving healthcare services in the wake of the coronavirus (COVID-19) outbreak. CMS further provided that the waivers will help enable beneficiaries to have access to healthcare services and allow...

Ohio Legislators Stand up to Predatory PBM Fees in 340B Drug Pricing Program

Ohio legislators have introduced bipartisan Senate and House bills aimed at curbing excessive fees charged by insurers and Pharmacy Benefit Managers to pharmacies and providers participating in the 340B Drug Pricing Program. The 340B Program, created in 1992 by the federal government, aims to provide certain safety net health providers with funding through a system whereby outpatient drug savings are passed along to the provider. Drug manufacturers participating in Medicaid...

Pharmacy Benefit Managers Contribute to the Growing Rate of Independent Pharmacy Closures, However, Pharmacies Can Fight Back

As another independent pharmacy closed its doors last week in Connecticut, the owner of the pharmacy identified that the rising costs of operations and direct and indirect remuneration (DIR) fees along with the decreasing reimbursement rates each year led to their closure. Unfortunately, this has been the ill-fated result of many independent pharmacy owners throughout the country when Pharmacy Benefit Managers (PBM) are permitted to own the end-retailer, and a...