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Pharmacy, Physician Dispenser, and Wholesaler ALERT: OIG’s Safe Harbor Proposed Rule Potentially Excludes Pharmacies, Physician Dispensers, and Wholesalers as Value Based Entity Participants

Value Based Care is the future of the United States healthcare system and the Office of the Inspector General (OIG) for the US Department of Health and Human Services is in full agreement. The OIG recently issued a Notice of Proposed Rulemaking that introduced updates to the Anti-Kickback Statute (AKS), significantly modernizing the regulatory landscape and encouraging the transition from fee-for-service reimbursement to a value-based model. The Proposed Rule aims...

Five Things Providers Must Know About Express Scripts’ Newly Implemented DIR Program

Specialty pharmacies and physician dispensers will experience a drastic reduction in Medicare net reimbursement rates from Express Scripts, Inc. (ESI) beginning in the plan year 2020. ESI has implemented a DIR Fee program in certain Medicare Part D networks, likely including Cigna following its purchase of ESI. ESI has followed the lead of other major PBMs. Declining net reimbursement rates are the number one Provider concern nationally. Here are the...

What Pharmacies Need to Know: Appearing in Front of a State Board of Pharmacy In this video, attorneys Jonathan E. Levitt, Esq. and Lucas W. Morgan, Esq. discuss what pharmacies should be aware of when appearing in front of a State Board of Pharmacy. Contact Frier Levitt today to speak to an attorney.

What is a Maximum Allowable Cost (MAC) Law? Attorneys Jonathan E. Levitt, Esq. and Lucas W. Morgan, Esq. discuss why pharmacies should be aware of when it comes to PBMs and Maximum Allowable Cost (MAC) laws, including: What is a MAC law? [0:01] Challenging MAC law/MAC appeals [2:12] Contact Frier Levitt today to speak to an attorney about Maximum Allowable Cost (MAC) laws.