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“Nurse Ambassadors” and California’s Suit Against AbbVie: The Growing Scrutiny of “White Coat Marketing”

Earlier this week, the California Insurance Commissioner filed a wide-ranging lawsuit against AbbVie, the maker of Humira, seeking over $1.2 billion in damages.  In addition to allegations of run-of-the-mill kickbacks to physicians, the lawsuit alleged an intricate network of "nurse ambassadors" designed to improperly boost prescriptions for Humira. This lawsuit, which was interestingly brought under California"s Insurance Frauds Prevention Act as part of a growing trend of State Insurance Commissioners...

The PillPack-Amazon Deal and the Importance of Developing a Strategic Plan for Compliance & Growth

It was recently announced that Amazon will be acquiring the online pharmacy, PillPack, for approximately $1 billion, with each of the founders receiving approximately $100 million each. PillPack's rise and success is one that all pharmacy owners strive for and hope to achieve. What can be learned from PillPack's success story is that in order to reach these goals, pharmacies need to have clear strategic and operational plans, to account...

PBMs Targeting Manufacturer Coupons and Copay Assistance in Pharmacy Audits

PBMs have increasingly begun targeting the usage of manufacturer sponsored coupon programs and copayment assistance programs in both desktop and on-site audits of pharmacies. As a result of these audits, PBMs are alleging discrepancy findings, and recouping money from pharmacies, based on a number of different factors, including, but not limited to, the usage of a coupon on a non-FDA approved drug. Of course, there are certain limitations on when...

Unique Issues and Challenges for Supermarket Specialty Pharmacies

Supermarket pharmacies have existed in the marketplace for nearly 60 years, with the number of outlets exploding in more recent times. Supermarket pharmacies have consistently averaged some of the highest customer-satisfaction scores among different pharmacy provider sites, resulting in over 15% of all prescriptions being dispensed from supermarket pharmacies. Over the last several years, with the increased importance and prevalence of specialty medications in the healthcare continuum, many supermarket pharmacies...

Don’t Come Up Short: Avoiding Inventory Shortfall Discrepancies When Purchasing Directly from Pharmaceutical Manufacturers

Pharmacy benefit managers (PBMs) have audited pharmacies on drug purchases for some time, seeking to compare total claims billed to the PBM versus quantities purchased by the pharmacy. When quantities billed to the PBM exceed the demonstrated inventory on hand by the pharmacy, the PBMs issue discrepancy findings and seek to take back large amounts from pharmacies. One trend that has begun to crop up more often in recent months...