Frier Levitt successfully negotiated network enrollment for an independent pharmacy into a national Pharmacy Benefit Manager (“PBM”) network. The Pharmacy’s enrollment application was initially denied by the PBM allegedly due to one of the... Read More
Frier Levitt successfully reversed a five year wait for readmission for an independent pharmacy into one of the largest Pharmacy Benefit Managers (“PBM”) pharmacy networks. More specifically, the pharmacy was terminated by the PBM in 2017 for... Read More
A new Indiana law, codified as Act No. 241 (the “Act”) came into effect on July 1, 2020, providing substantial protections for independent pharmacies operating in the State against various Post Point of Sale (“PPOS”) fees, like Direct and... Read More
While the majority of independent pharmacies have continued to see their margins shrink because of below market pricing and self-serving tactics implemented by Pharmacy Benefit Managers (“PBMs”) that only benefit themselves, Frier Levitt... Read More
Frier Levitt recently assisted Texas-based independent pharmacy that was facing a Fraud, Waste, and Abuse audit conducted by a major Pharmacy Benefit Manager (“PBM”) and successfully reduced the audit chargeback from over $1.3M to $190K. The... Read More
Frier Levitt previously reported that certain Direct and Indirect Remuneration (“DIR”) fee reports would be available soon from Pharmacy Benefit Managers (“PBMs”) and last week, a major PBM distributed its report to providers. Often, PBMs... Read More
As PBMs continue to subject pharmacies to strict credentialing terms, gaining network access becomes a difficult and daunting task, particularly for those located in designated “HEAT Zones” that often require enhanced credentialing.... Read More
Pharmacy Benefit Managers (“PBMs”) have developed a perverse technique to incentivize pharmacies to dispense more expensive brands, at the expense of Plan Sponsors and patients. Plan Sponsors seek to reduce their drug spend by encouraging the... Read More
In September 2018, New Jersey Governor Phil Murphy announced that the State of New Jersey awarded the PBM contract to OptumRx and agreed to pay OptumRx $6.7 billion over three years to manage and administer pharmacy benefits for the State. Under New... Read More
PBMs market themselves as “transparent” and purport to “pass through” all rebates to Plan Sponsors. However, recent litigation has brought that into question. We have seen alarming instances where PBMs secretly use little-known Rebate... Read More
