The Specialty drug spend in the United States is projected to increase 400% by 2020, but capturing a piece of that pie can be challenging. Specialty patients are coveted by Pharmacy Benefit Managers (PBMs) most of whom own their own Specialty Pharmacies. Express Scripts, Inc., Medco, Prime Therapeutics, Caremark and other PBMs own specialty pharmacies. PBMs often prevent independent pharmacies from joining specialty networks. These “network exclusions” often violate State and Federal law, but such exclusions can be challenged. Many legal concepts are critical to the growth of a Specialty Pharmacy, including network issues, State and Federal Any Willing Provider laws, regulations limiting specialty drug co-payments and limited distribution drug concerns. Frier Levitt attorneys have successfully fought on behalf of Specialty Pharmacies to gain entrance into restricted specialty pharmacy networks.
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