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New Jersey Law Grants Rights to Pharmacies Against PBM Post-Adjudication Fees and Mailing Prohibitions

On December 19, 2019, NJ Governor, Phil Murphy, signed into law an important new bill regulating PBMs, effective on March 18, 2020. The bill, A3717, passed with unanimous support in both legislative houses, amends the State’s current PBM regulations and outlaws post-adjudication fees by PBMs, such that: "After the date of receipt of a clean claim for payment made by a pharmacy, a pharmacy benefits manager shall not retroactively reduce...

Frier Levitt Recovers Over $300K in GER Withholdings From PSAO

Frier Levitt recently recovered over $300K held in reserve from a Pharmacy Services Administrative Organization (PSAO), which withheld the funds to due to Generic Effective Rate (GER) adjustments for the calendar year 2018. This is another major win for an independent pharmacy that suffered grave financial harm. Many pharmacies have begun receiving notices of GER adjustments, ranging from thousands to millions of dollars, without having an opportunity to examine any...

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...