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The End of Chevron Deference Could Foretell the Beginning of Equal Access to Care Under Medicaid

One cannot move in legal circles without hearing at least some discussion of the SCOTUS' position on the administrative state. With a now-entrenched conservative majority and at least two or three of those justices expressing doggedly anti-regulation views, many are asking if one of the venerable pillars of the administrative state—the doctrine known as "Chevron deference"—will ultimately be abrogated by the Court. The name "Chevron deference" is derived from the...

PHARMACY ALERT: OptumRx Sends “Notice of Potential Contract Breach” Regarding Buying from Non-VAWD Wholesalers

OptumRx is sending out a "Notice of Potential Contract Breach" to pharmacies in its network advising that the pharmacy is in breach of their agreement because the pharmacy is alleged to have purchased from non-VAWD accredited wholesalers and distributors. The Notice further requires the pharmacy to acknowledge, in writing, that purchasing from non-VAWD accredited wholesalers constitutes a Prohibited Activity under the parties' agreement and to affirm that the pharmacy will...

PHARMACY ALERT: Express Scripts Demands “Mail Order Attestation” Limiting Mail Order and Delivery Services

Recently, Express Scripts (ESI) has begun demanding independent retail pharmacies sign a "Mail Order Attestation," limiting the pharmacy's ability to provide mail order and delivery services to ESI members to only 10% of all claims submitted to ESI. Per ESI's correspondence, a failure to return an executed "Mail Order Attestation" in a timely manner will result in the pharmacy's termination from ESI’s network. Pharmacies have rights to challenge this unlawful...

Pharmaceutical Manufacturers, Wholesalers, and Distributors: Prepare for High Stakes Opioid Litigation

Earlier this year, Attorney General Jeff Sessions announced the creation of a task force to pursue the makers and distributors of prescription opioids and his intention for the Justice Department to play a substantial role in supporting plaintiffs throughout the country in prescription opioids-based lawsuits. In addition to the Justice Department's vocal support of such legal action, numerous lawsuits, including class action lawsuits, have already been filed throughout the United...

Kentucky Proposes Legislation Aimed at Increasing Medicaid Reimbursement Rates and PBM Oversight

Throughout the nation, independent pharmacies are facing lower and lower Medicaid reimbursement rates. These rates are making it harder for pharmacies to make ends meet as the rates often result in pharmacies being reimbursed at or less than their acquisition cost. In response to these unreasonable reimbursement rates, independent pharmacies have urged legislators, both at the state and federal level, to address the predatory reimbursement rates set by Pharmacy Benefit...