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PHARMACY ALERT: Roche Begins Issuing Demand Letters Seeking Repayment for Test Strips Claims

Pharmacies have begun receiving demand letters from Roche Diagnostics Corp. and Roche Diabetes Care, Inc. ("Roche'') for repayment of money as it relates to claims for vials/boxes of Roche Accu-Chek blood-glucose test strips. Roche states that, based on data gathered from rebate claims submitted by insurers, pharmacies received reimbursement for test strips intended for retail sale while actually dispensing discounted products, including test strips that are marked as Durable Medical...

PHARMACY ALERT: Express Scripts Subjects Pharmacies to Massive Recoupment and Termination for Purchases from Unauthorized Wholesale Drug Distributors

In a recent but aggressive trend, Express Scripts, Inc. (ESI) – the nation's largest Pharmacy Benefits Manager (PBM) – has begun auditing and recouping large sums of money from pharmacy providers stemming from drug purchases made from allegedly "unauthorized" wholesalers or distributors. Starting in or around June 2016, ESI began conducting extensive purchase verifications and imposing discrepancies on all claims for products not purchased from a wholesaler listed as an...

CVS and AIG Jointly Settle an Insurance Misrepresentation Dispute for $310 MM

CVS Caremark is in the news arising out of contract entered into more than twenty-five (25) years ago. In 1990, MedPartners Inc. (now Caremark) reached a $56 million settlement on a pending securities and derivative litigation after a failed merger with Nashville, Tennessee-based PhyCor Inc. Plaintiffs in the new litigation matter alleged that during the negotiations leading to a settlement in 1990, MedPartners and its insurance company, American Insurance Group...

OIG Signals More Stringent Enforcement on Limitations to Copayment Patient Assistance Programs

Earlier this year, the Office of Inspector General (OIG) revoked Advisory Opinion No. 10-06 previously issued in 2010 to a charitable Patient Assistance Program (PAP) that determined the financial assistance to Medicare beneficiaries, as described in the Advisory Opinion No. 10-06, did not violate the federal anti-kickback statute, 42 U.S.C. 1320a–7b. In revoking Advisory Opinion No. 10-06, the OIG referred to a Supplemental Advisory Bulletin regarding Independent Charity PAPs. The...

PBMs Continue to Wrongly Exclude Specialty Pharmacies From Networks, Often in Violation of Federal and State Law

Pharmacy Benefit Managers (PBMs) own their own Specialty Pharmacies (SPs) and convince Plan Sponsors to allow the PBMs to become the exclusive provider of expensive specialty drugs.  PBMs have recently enjoyed significant revenue expansion and resultant stock growth, largely derived from PBM tactics involving specialty drug dispensing and aggressive pharmacy network terminations. A look at recent PBM quarterly earnings announcements reveals this clear trend. The PBMs' motive to exclude independent...