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
Blogs & Articles | Defending Pharmacies in PBM Audits | Life Sciences | Pharmacy Law

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
Blogs & Articles | Community, Retail Pharmacies | Defending Pharmacies in PBM Audits | DIR Fees | Life Sciences | Maximum Allowable Cost Pricing & Appeals | Pharmacy Law | Specialty Pharmacies | Supermarket Pharmacies | White Collar Criminal Defense & Government Investigations

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
Blogs & Articles | Chain Pharmacies | Community, Retail Pharmacies | Digital Pharmacies | DIR Fees | Life Sciences | Pharmacy Law | Pharmacy Transactions

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
Blogs & Articles | Chain Pharmacies | Community, Retail Pharmacies | Defending Pharmacies in PBM Audits | Digital Pharmacies | Life Sciences | Long-Term Care Pharmacies | MAC Pricing & Appeals | News & Press | Pharmacy Law | Plan Sponsor PBM Contract Services

“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
Chain Pharmacies | Defending Pharmacies in PBM Audits | Life Sciences | News & Press | Pharmacy Law | Plan Sponsor PBM Contract Services

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
Blogs & Articles | Community, Retail Pharmacies | Defending Pharmacies in PBM Audits | Life Sciences | Pharmacy Law | State Board of Pharmacy Hearings and Professional Discipline

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
Blogs & Articles | Community, Retail Pharmacies | Defending Pharmacies in PBM Audits | Life Sciences | News & Press | Pharmacy Law

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
Blogs & Articles | Defending Pharmacies in PBM Audits | Life Sciences | Long-Term Care Pharmacies | Payor Network Access and Defense of Network Terminations | Pharmacy Law

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
Blogs & Articles | Chain Pharmacies | Community, Retail Pharmacies | Defending Pharmacies in PBM Audits | Life Sciences | Pharmacy Law | Pharmacy Transactions | Plan Sponsor PBM Contract Services

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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