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
In a recent trend, pharmacies have begun receiving notices of termination not for billing errors or audit findings, but for claims inactivity. Specifically, several Pharmacy Benefit Managers, or PBMs, have been terminating pharmacies solely because... Read More
Has your pharmacy or dispensing practice recently received a remittance that included large “submission fees,” sometimes designated with the code “AH:444,” without explanation? Frier Levitt has learned those fees are DIR fees being charged... Read More
It is a challenging task to open and sustain an independent, retail pharmacy business, particularly given the current landscape. However, even more challenging, is establishing a pharmacy in a “HEAT Zone.” The Health Care Fraud Prevention and... Read More
As part of an invoice reconciliation audit, Pharmacy Benefit Managers (“PBMs”) routinely request pharmacies to provide documents pertaining to pharmacy-to-pharmacy drug transfers. These documents include invoices and/or purchase summaries from... Read More
