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Unique Issues and Challenges for Supermarket Specialty Pharmacies

Supermarket pharmacies have existed in the marketplace for nearly 60 years, with the number of outlets exploding in more recent times. Supermarket pharmacies have consistently averaged some of the highest customer-satisfaction scores among different pharmacy provider sites, resulting in over 15% of all prescriptions being dispensed from supermarket pharmacies. Over the last several years, with the increased importance and prevalence of specialty medications in the healthcare continuum, many supermarket pharmacies...

Prime Therapeutics, LLC Takes Steps to Exclude New Dispensing Physicians from Its Pharmacy Network

Prime Therapeutics has announced that it will no longer accept Dispensing Physician entities into its pharmacy network starting January 29, 2018.  The PBM will begin blocking PSAOs from adding physician dispensers.  We also anticipate that Prime Therapeutics will likely increase auditing scrutiny on existing Dispensing Physician entities through aggressive audits and investigations. Legal tools exist to challenge Prime's decision.  This affront to the healthcare system follows the misguided path CVS...

PHARMACY ALERT: Major PBMs Release Specialty Network Pricing Below Acquisition Cost for Many Pharmacies

As the plan year changes, many PBMs update their reimbursement rates and pricing structures for their various plans. Express Scripts has begun to release reimbursement rates applicable to specialty pharmacies, and many pharmacies are finding that rates are so low that reimbursement will not even cover the costs to acquire the medication. In late 2016, Express Scripts began circulating a specialty provider questionnaire and application to pharmacies that have been...

PHARMACY ALERT: Roche Continues Alleging Pharmacy Wrongdoing and Seeking Repayment for Test Strips Claims

In recent months, Roche has demanded large payments from pharmacies that dispense Roche's Accu-Check blood-glucose test strips (also called vials by Roche). Roche alleges that pharmacies have submitted reimbursement claims for Roche's retail version of Accu-Check blood-glucose test strips but were involved in a "scheme" whereby it obtains and sells discounted vials of Roche durable medical equipment (DME) Accu-Check test strips. In its letter to pharmacies, Roche threatens to sue...

NADAC Pricing and Aggressive PBM Prior Authorization Tactics: How Specialty Pharmacies Can Respond

Nearly every day, independent specialty pharmacies face industry changes that threaten their businesses. This year, two changes have been especially impacting – the implementation of the NADAC pricing benchmark and enhanced and aggressive prior authorization protocols and policies implemented by PBMs. Unfortunately, the implementation of the National Average Drug Acquisition Cost (NADAC) benchmark has been devastating to some pharmacies, which are often reimbursed at or below acquisition cost. Similarly, independent...