PBM Archives - Frier Levitt - Attorneys at Law

Eighth Circuit Upholds North Dakota Statutes Regulating PBM Conduct in Post-Rutledge World

Todd Mizeski, Esq. and Geordan L. Ferguson, Esq. November 22, 2021

On November 17, 2021, the Eighth Circuit rendered its highly anticipated decision in Pharmaceutical Care Management Associated v. Wehbi, which is the first federal court of appeals decision to apply the ERISA preemption analysis set forth by the... Read More

Delaware Enacts New Pharmacy Benefit Manager Law Regulating PBMs

A.J. Barbarito, Esq. and Todd Mizeski, Esq. November 5, 2021

On October 26, 2021, Delaware’s new law regulating PBMs took effect. The law, HB219, regulates PBMs in multiple ways, and Insurance Commissioner Trinidad Navarro recently made a statement confirming that the Delaware Department of Insurance will... Read More

Pharmacy Provider Alert: DIR Fees Continue to Increase

Steven L. Bennet, Esq. and Brenna Sackman, Esq. October 25, 2021

Direct and indirect remuneration (DIR) fees paid by pharmacy providers to pharmacy benefit managers (PBMs) are on the rise for the upcoming calendar year in 2022. Pharmacy DIR fees have been utilized by PBMs to recoup monies on claims submissions... Read More

New York Legislature Passes Bill Introducing Private Right of Action for Pharmacies and New Constraints on PBM Practices

Geordan L. Ferguson, Esq., A.J. Barbarito, Esq. and Todd Mizeski, Esq. October 21, 2021

The New York Legislature recently passed legislation which it has now sent to the Governor, Kathy Hochul, for signature. If signed, the “Pharmacy Rescue Package” will provide new opportunities for NY-based pharmacies and will provide much-needed... Read More

Dae Lee, Pharm.D., Esq., CPBS Quoted in Article on PBMs in Employee Benefit News

Dae Y. Lee, Esq., Pharm.D CPBS October 19, 2021

“Even if there's contract language in place to prohibit this from happening, we see the same self-serving tactics,” In a recent article in Employee Benefit News called, “An attorney shares the warning signs of 'self-serving' PBMs ” Frier... Read More

PBMs Continue to Scrutinize Claims Submitted During COVID-19 Pandemic

Dae Y. Lee, Esq., Pharm.D CPBS October 8, 2021

Pharmacy Benefit Managers (“PBMs”) continue to scrutinize pharmacies for prescription claims submitted during the coronavirus outbreak (“COVID-19”). Importantly, many PBMs, payors, and governmental bodies including the Center for Medicare... Read More

Benefits PRO article on How PBM “Rebate Walls” Impact Drug Spending, Patient Care and Competition by Jonathan Levitt, Dae Lee, Jesse Dresser and Andreas Stargard

Jonathan E. Levitt, Esq., Jesse C. Dresser, Esq., Dae Y. Lee, Esq., Pharm.D CPBS and Andreas Stargard, Esq. October 4, 2021

Frier Levitt attorneys Jonathan Levitt, Esq. , Dae Y. Lee, Pharm.D., Esq., CPBS, Jesse C, Dresser, Esq. and Andreas Stargard, Esq. discuss how PBM “rebate walls” impact drug spending, patient care and competition in a recent issue of... Read More

Long-Term Care Pharmacies and Pharmacy Benefit Manager Network Credentialing

Harini Bupathi, Esq. and Jesse C. Dresser, Esq. September 24, 2021

To gain admission to a Pharmacy Benefit Manager ("PBM") pharmacy network, long-term care (LTC) pharmacies are expected to undergo a credentialing process. Generally, the credentialing process for an LTC pharmacy is similar to that of a retail... Read More

Final Rule Effective in 2022 for Medicare Part D and What It Means for Pharmacies

Steven L. Bennet, Esq., Brenna Sackman, Esq., Jesse C. Dresser, Esq. and Todd Mizeski, Esq. September 23, 2021

Effective on January 1, 2022, the Centers for Medicare & Medicaid Services (CMS) and the Department of Health and Human Services (HHS) will implement the Final Rule for Medicare and Medicaid Programs. The Final Rule establishes pharmacy... Read More

Frier Levitt Successfully Reverses PBM Network Termination for Georgia Pharmacy

Dae Y. Lee, Esq., Pharm.D CPBS September 22, 2021

Frier Levitt successfully reversed network enrollment denial by a national Pharmacy Benefit Manager (“PBM”) against a Georgia-based pharmacy. The PBM conducted a desktop audit along with invoice reconciliation. While the PBM did not find... Read More

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