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Hot Topics in Specialty Pharmacy Law: PBM Prescription Trolling, HUB Arrangements, DIR Fees Update, Opioid and Naloxone Laws, and NADAC Pricing

    Download the webinar slides. The specialty pharmacy industry has dramatically changed over the past few years and is now one of the fastest growing sources of revenue in the prescription drug marketplace. As a result, payers and PBMs have adopted numerous policies and tactics to maximize PBM profits and drive patient traffic away from independent pharmacies. These policies and tactics, along with current healthcare regulations, have created challenges...

The Impact of DIR Fees on 340B Relationships Between Contract Pharmacies and Covered Entities

The impact of Direct and Indirect Remuneration ("DIR") fees on the specialty pharmacy industry cannot be overstated and has been widely reported in White Papers and industry news reports. However, the impact of DIR fees on the 340B sector is only now being realized. In the first of a series of articles, Frier Levitt explores the basics of DIR Fees as applied to 340B. The 340B Drug Discount Program ("340B")...

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...