On Monday, June 6, 2022, the Federal Trade Commission (FTC) voted unanimously to approve a “6(b)” study into the anti-competitive and abusive practices of Pharmacy Benefits Managers (PBMs), a move that has the potential to lead to significant... Read More
Antitrust Tools Available to Combat PBM Abuse of Pharmacies | Articles | Chain Pharmacies | Community, Retail Pharmacies | Defending Pharmacies in PBM Audits | DIR Fees | Life Sciences | Pharmacy Law | Specialty Pharmacies

In yet another high-profile legal action, health insurance giant, Humana, has demonstrated its appetite to go after pharmaceutical manufacturers, supporting hubs and specialty pharmacies involved in patient assistance programs.  This past week,... Read More
Articles | Life Sciences | Medicare, Medicaid, and Other Commercial Payor Audits & Appeals | Pharmaceutical Manufacturers | Pharmacy Law | Specialty Pharmacies

In September 2020, Frier Levitt described how Humana Pharmacy Solutions, Inc. and affiliated Humana entities (“Humana”) filed a lawsuit against a Florida-based telemedicine company, QuivvyTech Corp., and its affiliated physicians (“QuivvyTech... Read More
All types of single and multi-specialty medical practice groups | Articles | Healthcare | Healthcare Law | Healthcare Practice Compliance | Physicians and Medical Practices of all Specialties | Telehealth and Telemedicine

Following the release of an April 16, 2021 HHS Office of Inspector General (“OIG”) report entitled “Medicare Advantage Compliance Audit of Diagnosis Codes that Humana, Inc. (Contract H1036) Submitted to CMS” (the “OIG Report”), headlines... Read More
All types of single and multi-specialty medical practice groups | Articles | Healthcare | Healthcare Law | Healthcare Litigation | Medicare and Insurance Audits | Medicare, Medicaid, and Other Commercial Payor Audits & Appeals | News | Value Based Care

On August 20, 2020, Humana Pharmacy Solutions, Inc. (“Humana”) filed a lawsuit alleging, among other things, violations of the Racketeer Influenced and Corrupt Organizations Act (“RICO”) against a Florida-based company, Quivvy Tech Corp.,... Read More
Articles | Life Sciences | Telehealth and Telemedicine

In an effort made in response to the COVID-19 emergency thus far, as previously discussed in our posts, “What Are the PBMs Doing Amid COVID-19 Crisis: Waivers from Strict Requirements May Exist for Independent Pharmacies,” and “UPDATE: Humana... Read More
Articles | COVID-19 Resources | Defending Pharmacies in PBM Audits | Pharmacy Law

As previously discussed in our post, “What Are the PBMs Doing Amid COVID-19 Crisis: Waivers from Strict Requirements May Exist for Independent Pharmacies,” many healthcare companies alike are taking further actions to ensure that patients have... Read More
Articles | Chain Pharmacies | Community, Retail Pharmacies | Defending Pharmacies in PBM Audits | Life Sciences | Pharmacy Law | Specialty Pharmacies

According to the 2015 Form 10-K filed by the drug manufacturer Insys Therapeutics, Inc., Humana began sending letters to its participating pharmacy providers in January 2016 "indicating that as a result of a CMS audit, Humana was initiating a... Read More
Payor Network Access and Defense of Network Terminations | Pharmacy Law