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New Jersey’s New “Prescription Drug Patient Protection Act” Will Regulate PBMs and Limit Use of Prior Authorization

The "Prescription Drug Patient Protection Act" has recently passed both houses of the Legislature in New Jersey and is currently awaiting signature by Governor Phil Murphy. The Bill establishes a host of new requirements to be followed by PBMs offering services in the state, including certain prohibitions regarding the Prior Authorization process. If signed into law by the Governor, it could greatly impact PBMs that are currently operating in New...

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...

CLASS ACTION ALERT: Pharmacy Benefit Managers (PBMs) Are Tricking Patients Into Paying Higher Copayments Than The Actual Cash Price For Their Medications

We are receiving information about a disturbing new trend involving potential price gouging by PBMs. PBMs may have been charging patients  copayments for prescription drugs that exceed the actual cash price of the drug. PBMs later recoup from the Pharmacy the difference in value between the price of the drug and the higher copayment Patient lose by paying more than reasonably required. PBMs win.  PBMs, who serve as the middle...

Qui Tam Lawsuits Are Becoming an Increasingly Popular Tool to Combat False Claims Act Violations

A New Jersey federal court has ordered Nita K. Patel, Kirtish N. Patel and their two diagnostic testing companies, Biosound Medical Services, Inc. and Heart Solution P.C., to pay more than $7.75 million for knowingly submitting claims to the United States Government for falsified diagnostic testing reports. In its Complaint, the Government accused the defendants of developing a fraudulent scheme to create falsified diagnostic testing reports, forge physician signatures on...

“Test Case” Arbitrations an Effective Alternative to Class Action Arbitrations for Independent Pharmacies Challenging PBM Audits

Class action arbitrations were one of the most powerful tools in a lawyer's arsenal to help independent pharmacies force nation-wide changes to abusive PBM auditing conduct. A class action arbitration is a procedural device that permits one or more independent pharmacies to file and prosecute a claim on behalf of a larger group of independent pharmacies. Without class action arbitrations, independent pharmacies looking to challenge abusive PBM practices are forced...