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Frier Levitt Successfully Reverses Termination from PBM Network for a New York Pharmacy

A New York Pharmacy's network termination by a major PBM for a was recently rescinded as the result of emergent intervention from Frier Levitt. The PBM was alleging discrepancies in the pharmacy's credentialing document and, although the pharmacy's principal never made any intentional misrepresentations, the PBM nevertheless terminated the pharmacy and plan sponsors sent out notices to the pharmacy's patients. Frier Levitt assisted at all stages of the dispute. Frier...

Drug Wholesaler’s Criminal Prosecution Provides Case-Study for Compliance Do’s and Don’ts

Rochester Drug Cooperative (RDC) recently entered into a plea with the federal government in which it admitted wrongdoing and agreed to pay $20 million in fines, receiving a prosecution deferral subject to a three-year monitoring period by an independent compliance official. Moreover, the government brought criminal charges against former CEO Laurence F. Doud III and William Pietruszewski, the former chief of compliance. Pietruszewski has reportedly entered a plea and is...

Arkansas Seeks U.S. Supreme Court Review of Eighth Circuit Ruling Striking Down MAC Law

Back on October 22, 2018, the state of Arkansas filed a petition for a writ of certiorari with the U.S. Supreme Court, asking them to review the U.S. Court of Appeals for the Eighth Circuit’s decision, specifically asking the Supreme Court to consider "[w]hether the Eighth Circuit erred in holding that Arkansas's statute . . . is preempted by ERISA[.]" Most recently, on April 15, 2019, the Supreme Court invited...

Medical Supply Wholesaler Wins Insurance Coverage Dispute for Abbott Litigation

Last month, the Wisconsin Supreme Court ruled that West Bend Mutual Insurance Co. was required to defend a medical supply wholesaler in a lawsuit alleging it sold "gray market" versions of Abbott Laboratories' diabetes test strips. The Court found that even though Abbott alleged that the wholesaler had acted in an intentional manner, the insurance policy could not escape its "duty to defend" where other claims alleged were covered by...

Pharmacies Face Expanded “Effective Rate” Withholdings from PSAOs

Late last year, Epic Pharmacy Network, Inc. (Epic) sent demands to network pharmacies notifying its members that it will withhold future payments because of a Generic Effective Rate (GER) adjustment. The adjustments surprised many pharmacies that were unaware of any withholding resulting in multiple state and federal court lawsuits. Now, in 2019, pharmacies must be as diligent as ever to ensure that Pharmacy Services Administration Organizations (PSAOs) and Pharmacy Benefit...