As a follow-up to our May 18, 2021 article, the bipartisan piece of legislation that unanimously passed the Texas House and Senate aimed at regulating pharmacy benefit managers (PBMs) was signed into law by Governor Greg Abbott. This is a huge win... Read More
Physician groups contracting with government-regulated health plans such as Medicare-Advantage Organizations, Medicaid Managed Care Organizations, or ACA Marketplace Individual/Small Group Issuers often enter into capitated payment models with... Read More
Express Scripts, Inc. (“ESI”), has switched gears once again in its recoupment efforts that originally began on April 7, 2020, and re-initiated by ESI on September 1, 2020 . ESI unilaterally recoups funds from pharmacies based on an alleged... Read More
The current United States marketplace for the regulation of pharmacy benefits is a patchwork of inconsistent (and in some cases non-existent) state laws, state and federal agency regulations, agency manuals and federal laws. Uniform state laws would... Read More
Over 185,000 Americans and counting have lost their lives battling COVID-19. Health care providers have fought hard for patients and the Government has granted them, along with vaccine manufacturers, broad immunity from liability. However, victims... Read More
Frier Levitt Co-Founder Jonathan Levitt, Partner Jesse Dresser and pharmacist-attorney Dae Y. Lee recently authored an article for Managed Healthcare Executive on "Why Timing Matters When It Comes to PBM Contracting." Timing plays a... Read More
Pharmacy Benefit Managers (PBMs) Maximum Allowable Cost or “MAC” pricing continues to be one of the most challenging issues facing independent pharmacies throughout the United States—MAC is one of the primary ways in which PBMs reimburse... Read More
As COVID-19 grips the national economy, pharmacies are not immune from the financial fallout. Challenging PBMs’ abusive DIR fee recoupments is more important than ever to preserve the viability of independent pharmacy. As pharmacies struggle to... Read More
