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
Pharmacy Benefit Managers (PBMs) have been known to conduct regular audits of pharmacies. One such audit includes an invoice reconciliation, or inventory audit, of the pharmacy. In a growing trend, we have seen PBMs place many expectations on the... Read More
In a growing trend, Pharmacy Benefit Managers (PBMs) have taken issue with a pharmacy’s alleged common ownership and/or affiliation with other pharmacies, particularly those that (i) have been previously terminated from the PBM’s pharmacy... Read More
After a pharmacy gains admission into a PBM’s pharmacy network, the pharmacy can expect to receive regular re-credentialing requests. Generally, these re-credentialing requests ask that the pharmacy confirm that the information they previously... Read More
State legislative initiatives to regulate Pharmacy Benefit Managers (“PBMs”) have gained momentum. Arkansas successfully defended its state PBM regulation in 2020 before the United States Supreme Court. Now, more states have been enacting... Read More
As we reported here, Plan Sponsors have begun elevating their challenges of Pharmacy Benefit Managers’ (“PBMs”) and Managed Care Organizations’ (“MCOs”) conduct, from PBM pricing to auditing and litigating over PBM practices such as... Read More
A piece of legislation aimed at regulating pharmacy benefit managers (PBMs) and protecting Independent Pharmacies in the State of Tennessee recently passed through the State’s House and Senate and was subsequently signed into law by Governor Bill... Read More
https://youtu.be/g2dpr-g6sCQ Pharmacies must stay vigilant in the MAC process. Frier Levitt’s Jonathan Levitt, Esq. and Lucas Morgan, Esq. talk about MAC Laws and what’s new with Maximum Allowable Cost Appeals in our latest video. Learn what... Read More
A bipartisan piece of legislation aimed at regulating pharmacy benefit managers (PBMs) in the State of Texas unanimously passed the House and Senate in Texas. Specifically, House Bill (HB) 1763 previously passed the Texas House by a vote of 147-0... Read More
On April 12, 2021, Senator Kolkhorst, along with a bipartisan group of cosponsors, introduced SB 2195, a Bill that prohibits Pharmacy Benefit Managers (“PBMs”) operating in Texas from assessing against pharmacies a variety of different types of... Read More
