After nearly 40 years, the Chevron Doctrine – a long-standing legal doctrine that requires courts to show great deference to agency decisions interpreting ambiguous rules created pursuant to power delegated by Congress – may be on the verge of... Read More
Articles | Healthcare | Healthcare Law | Life Sciences

Congress has recently increased its scrutiny of Pharmacy Benefit Managers (“PBMs”), coinciding with a crucial policy shift by the Federal Trade Commission (“FTC”) that appears promising for independent pharmacies and other providers seeking... Read More
Antitrust Tools Available to Combat PBM Abuse of Pharmacies | Articles | Chain Pharmacies | Community Oncology Practices & Other Dispensing Physician Practices | Community, Retail Pharmacies | Defending Pharmacies in PBM Audits | Digital Pharmacies | DIR Fees | Fertility Pharmacies | Integrated Delivery Network and Hospital System Pharmacy | Long-Term Care Pharmacies | MAC Pricing & Appeals | Manufacturers | Maximum Allowable Cost Pricing & Appeals | Pharmaceutical Manufacturers | Pharmaceutical Wholesalers | Plan Sponsor PBM Contract Services | Specialty Pharmacies | Supermarket Pharmacies | Traditional Compounding Pharmacies (503A)

On March 27, 2023, South Dakota Governor Kristi Noem signed into law HB 1135, providing South Dakota consumers and providers with a much-needed dose of transparency in prescription drug pricing. HB 1135 amends existing legislation and introduces new... Read More
Antitrust Tools Available to Combat PBM Abuse of Pharmacies | Articles | Chain Pharmacies | Community, Retail Pharmacies | Defending Pharmacies in PBM Audits | Digital Pharmacies | Fertility Pharmacies | Integrated Delivery Network and Hospital System Pharmacy | Long-Term Care Pharmacies | Specialty Pharmacies | Supermarket Pharmacies | Traditional Compounding Pharmacies (503A)

Earlier this month, House Representative Earl L. (“Buddy”) Carter (R-GA) introduced the Drug Price Transparency in Medicaid Act of 2023 (H.R. 1613) (the “Act”) in an effort to improve transparency and curb abusive practices related to the... Read More
Antitrust Tools Available to Combat PBM Abuse of Pharmacies | Articles | Medicare Advantage Risk Adjustment Litigation | Medicare Audit Appeals | Plan Sponsor PBM Contract Services

On February 16, 2023, the Senate Commerce Committee held a full committee hearing titled “Bringing Transparency and Accountability to Pharmacy Benefit Managers.” The purpose of the hearing was to hear from industry actors as the Committee... Read More
Antitrust Tools Available to Combat PBM Abuse of Pharmacies | Articles | Defending Pharmacies in PBM Audits | Plan Sponsor PBM Contract Services

Pending before Wyoming’s Joint Judiciary Committee is new legislation (HB 191) targeting the abusive practices of pharmacy benefit managers (“PBMs”) and granting pharmacies a private right of action to seek redress for damages caused by... Read More
Antitrust Tools Available to Combat PBM Abuse of Pharmacies | Articles | Biotech Companies | Chain Pharmacies | Clinically Integrated Networks (CINs) | Community Oncology Practices & Other Dispensing Physician Practices | Community, Retail Pharmacies | Defending Pharmacies in PBM Audits | Digital Pharmacies | DIR Fees | Dispensing Physician Practices and Dispensing Physicians | Fertility Pharmacies | Home Infusion Providers | Hospitals and Healthcare Systems | Integrated Delivery Network | Integrated Delivery Network and Hospital System Pharmacy | Long-Term Care Pharmacies | Physician Dispensing | Section 340B In-House and Contract Pharmacies | Specialty Pharmacies | Supermarket Pharmacies | Traditional Compounding Pharmacies (503A) | Urologist

Major healthcare and hospital systems are the latest victims in the growing trend amongst insurers and payors who are refusing to reimburse health care providers for their services. Most recently, Valley Health System (“Valley”) filed suit... Read More
Articles | Hospitals and Healthcare Systems | Professional Practice Representation

The recent increase in proposed State Legislature across the U.S. in an effort to regulate Pharmacy Benefit Managers (“PBMs”) demonstrates rising scrutiny by the government into the abusive conduct of PBMs and the impact it has on American... Read More
Antitrust Tools Available to Combat PBM Abuse of Pharmacies | Plan Sponsor PBM Contract Services

On June 15, 2022, the Supreme Court of the United States ruled unanimously in favor of several hospital groups concluding that the Department of Health and Human Services (HHS) exceeded its statutory authority by implementing a discriminatory... Read More
340B Covered Entity and Contract Pharmacy Regulatory and Contract Support | Articles | Healthcare Litigation | Hospitals and Healthcare Systems | Medicare and Insurance Audits