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Frier Levitt Wins Preliminary Injunction Against PBM for New York Pharmacy

Frier Levitt recently commenced an emergency arbitration against a PBM that had scheduled a termination against a pharmacy client. The PBM had subjected the pharmacy to an audit and had terminated the pharmacy based upon the results of the audit. The pharmacy argued it had presented the PBM with ample evidence to refute the audit results and, after the hearing on the preliminary injunction, the arbitrator found the pharmacy had...

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...

Frier Levitt Negotiates Access to PBM Network for Previously Denied Pharmacy

Frier Levitt recently negotiated a contract with a PBM network for a pharmacy that had been denied entry on several previous occasions. The pharmacy had applied for a contract numerous times and was denied for various reasons for more than a year, eventually seeking legal assistance from Frier Levitt. Frier Levitt intervened and through application of in-depth knowledge of legal requirements and the PBM application process, assisted the pharmacy to...

Pharmaceutical Wholesaler ALERT: Manufacturer Targeting Wholesalers for Allegedly Exploiting Returns Process

A major pharmaceuticals manufacturer may be targeting wholesalers and other distributors who allegedly exploited the manufacturer's returns process. The manufacturer appears to be alleging that distributors fraudulently represented the source of certain drugs, or that they falsely represented the circumstances of their purchase of the drugs, in order to allegedly induce the manufacturer or their agent to accept them through its return goods program and pay out reimbursements in accordance...

NYC Transit Authority sues Express Scripts for Failing to Effectively Manage its Prescription Drug Benefit Plan

A recent lawsuit filed by the New York City Transit Authority (NYCTA) raises important considerations for plan sponsors and agencies, such as the NYCTA, that retain the services of Pharmacy Benefits Managers (PBMs). On May 16, 2019, the NYCTA sued Express Scripts in New York state court alleging six counts for breach of contract. The NYCTA alleges that since retaining Express Scripts to manage its prescription drug benefit plan, "the...