PBM Archives | Frier Levitt - Attorneys at Law

Frier Levitt Successfully Obtains a $6.25 Million Settlement on Behalf of Its Plan Sponsor Client Against a Pharmacy Benefits Manager

Christopher Caltavuturo, Esq., Dae Y. Lee, Esq., Pharm.D CPBS and Todd Mizeski, Esq. December 23, 2020

Frier Levitt recently obtained a $6.25 Million settlement against a Pharmacy Benefits Manager(“PBM”) on behalf of its Plan Sponsor client (“Plan”). The Plan contracted with the PBM to administer its prescription drug program, and to... Read More

Master the Margin – Pharmacy Influencer Series: Trends in Reimbursement Solutions

Jesse C. Dresser, Esq. December 18, 2020

Frier Levitt Life Sciences Partner, Jesse C. Dresser, Esq. participated in a Master the Margin webinar with Ollin Sykes, CPA and Scotty Sykes, CPA, CFP® , both of Sykes & Company, P.A. to discuss recent trends in reimbursement... Read More

Community, Retail Pharmacies | DIR Fees | Life Sciences | Pharmacy Law | Webinars

PBM Licensure and Regulation Model Act

Martha M. Rumore Pharm.D., Esq., Jesse C. Dresser, Esq. and Jonathan Levitt November 30, 2020

The current United States marketplace for the regulation of pharmacy benefits is a patchwork of inconsistent (and in some cases non-existent) state laws, state and federal agency regulations, agency manuals and federal laws. Uniform state laws would... Read More

Blogs & Articles | Defending Pharmacies in PBM Audits | Life Sciences | Plan Sponsor PBM Contract Services

Provider Alert: Caremark Trimester 2 Reports of Year 2020 are now available

Brenna Sackman, Esq. and Steven L. Bennet, Esq. November 24, 2020

Pharmacy benefits manager (PBM) Caremark has now placed Trimester 2 reports for year 2020 in the Caremark Provider Portal. Caremark provides its summaries of Direct and Indirect Remuneration (DIR) Fees paid by pharmacy providers in these... Read More

Blogs & Articles | Community, Retail Pharmacies | DIR Fees | Life Sciences

Part 4 of 4: Abusive PBM Audit Practices (Bona Fide Prescriber-Patient Relationship)

Payal Amin, Pharm.D., RPh, Esq. and Dae Y. Lee, Esq., Pharm.D CPBS November 4, 2020

During a pharmacy audit, Pharmacy Benefit Managers (“PBMs”) often request the pharmacy to submit documents demonstrating that prescriptions were prescribed pursuant to a bona fide prescriber-patient relationship. If the pharmacy is unable to... Read More

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

Frier Levitt Successfully Reverses PBM Network Access Denial

Payal Amin, Pharm.D., RPh, Esq. and Dae Y. Lee, Esq., Pharm.D CPBS October 20, 2020

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

Blogs & Articles | Community, Retail Pharmacies | Life Sciences | Recent Results

Frier Levitt is Successful in Reversing Readmission Denial

Brenna Sackman, Esq., Dae Y. Lee, Esq., Pharm.D CPBS and Steven L. Bennet, Esq. August 25, 2020

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

Indiana Law Prohibiting PBM Post Point of Sale Fees, Reforming MAC Protections and other Protections for Independent Pharmacies Now in Effect

A.J. Barbarito, Esq., Todd Mizeski, Esq. and Lucas W. Morgan, Esq. August 11, 2020

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

Blogs & Articles | Pharmacy Law

PHARMACY ALERT: New Medicare Part D Claim Recoupment By PBMs

Payal Amin, Pharm.D., RPh, Esq. and Dae Y. Lee, Esq., Pharm.D CPBS July 29, 2020

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

Blogs & Articles | COVID-19 Resources | Pharmacy Law

Frier Levitt Successfully Reduces PBM Audit Chargeback by $1.1M

Dae Y. Lee, Esq., Pharm.D CPBS July 8, 2020

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

Blogs & Articles | Pharmacy Law