Frier Levitt successfully challenged and reversed discrepancies worth $1 million that were identified during an audit conducted by a major pharmacy benefit manager (PBM) against a Georgia-based independent pharmacy. During the audit, the PBM... Read More
Frier Levitt successfully reversed a network enrollment denial by a major Pharmacy Benefit Manager (“PBM”) against a New Jersey-based community pharmacy. Since the pharmacy is located in a city identified as being in a “HEAT Zone,” the PBM... Read More
Combatting opioid diversion remains a top priority for regulators and enforcement agencies. In that vein, there continues to be enhanced scrutiny on healthcare professionals over opioid prescriptions. As highlighted by recent Department of... Read More
In an effort to gain market access for new drugs and to shift the conversation from one of “volume” to one of “value,” pharmaceutical manufacturers are increasingly offering and agreeing to alternative payment models that set the price of a... Read More
The Inflation Reduction Act of 2022 (the “Act”), signed into law on August 16, 2022, contains several provisions aimed at reigning in prescription drug costs for Medicare beneficiaries. From a high level, these provisions include the imposition... Read More
Effective January 1, 2023, California has enacted several state laws impacting the practice of pharmacy. While these newly enacted laws are specific to California, pharmacy stakeholders in other jurisdictions should be mindful of these changes, as... Read More
Earlier this month, the Centers for Medicare and Medicaid (“CMS”) released a Memorandum overviewing next steps in the federal government’s implementation of the Medicare Drug Price Negotiation Program. Though CMS has only just “set the... Read More
In its campaign against the corruption of medical decision making and illegal kickbacks, the Department of Justice (“DOJ”) has increasingly come to rely upon two pieces of legislation together with the Federal Anti-Kickback Statute (“AKS”):... Read More
Drug manufacturers and patients are being negatively impacted by the increasing use of insurer copay accumulator and maximizer programs. These programs prevent manufacturer assistance, such as co-pay coupons, from being applied towards a patient's... Read More
On August 3, 2022, an Illinois federal jury returned a verdict ordering Eli Lilly & Co. (“Eli Lilly”) to pay $61 million for violations of the Federal False Claims Act (“FCA”) and adjacent state FCA laws. According to a qui tam lawsuit... Read More
