The “law” applicable to drug reimbursement encompasses an array of laws across 50 states, the territories, and the federal government. These laws and regulations determine what a “Plan Sponsor” (such as an insurance plan, State Medicaid... Read More
Independent pharmacies face numerous challenges and obstacles when being audited by pharmacy benefit managers (PBMs). One audit related tactic utilized by PBMs that is causing financial harm to independent pharmacies throughout the country is the... Read More
One of the most challenging issues for independent pharmacies throughout the United States is the issue of pharmacy benefit managers’ (PBMs) reimbursement practices. There are numerous ways in which PBMs dictate reimbursement to independent... Read More
Throughout the country, several states have engaged in ongoing efforts to enact or enhance state laws aimed at regulating pharmacy benefit managers (PBMs) and certain PBM practices, including audit and reimbursement practices, causing economic harm... Read More
Frier Levitt was recently successful in reversing a Midwest pharmacy’s enrollment application denial by a major Pharmacy Benefit Manager (“PBM”). The PBM denied the pharmacy’s enrollment application alleging that the pharmacy was previously... Read More
Many pharmacies are faced with PBM audits resulting in final audit finding recoupments which can range from very large to very small dollar amounts. Many times, when the recoupment is smaller in sum, pharmacies may be inclined to forgo contesting... Read More
Frier Levitt has noticed an increasing trend in State Board of Pharmacy investigations being commenced that closely mimic audit findings issued by Pharmacy Benefit Managers (“PBMs”). These Board of Pharmacy investigations place additional... Read More
The specialty pharmacy space has proven to be a rewarding investment for private equity, as specialty medications typically lead the pharmacy trend cost curve, which will only continue as more than 60 new specialty medications expected to receive... Read More
"Pharmacy Benefit Managers, or PBMs, have a major say in determining prescription drug prices and availability, but few people—including doctors—understand these organizations or what they do." Frier Levitt Co-Founding Partner, Jonathan... Read More
As we have reported in prior manufacturer rebate articles, Pharmacy Benefit Managers (“PBMs”) have created opaque manufacturer rebate arrangements, either directly or through wholly owned subsidiaries. These subsidiaries are “Rebate... Read More
