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
Blogs & Articles | Community, Retail Pharmacies | Defending Pharmacies in PBM Audits | Life Sciences | Pharmacy Law | Regulatory Compliance, including FDA, DEA and HIPAA

As Congress has made changes to the health care system over the past 30 years, nothing has impacted consumers' lives as much as the growth of pharmacy benefit managers (PBMs). Most consumers might not think that PBMs play a large role in their... Read More
Blogs & Articles | Community, Retail Pharmacies | Defending Pharmacies in PBM Audits | Life Sciences | Maximum Allowable Cost Pricing & Appeals | News & Press | Pharmacy Law | Plan Sponsor PBM Contract Services

Earlier this year, we discussed the impact of mandatory “white bagging” on providers, and more importantly, patients. Briefly, white bagging is a practice where a medication is ordered by a physician for in-office administration (e.g., IV... Read More
Blogs & Articles | Community, Retail Pharmacies | Dispensing Physician Practices and Dispensing Physicians | Hospitals and Healthcare Systems | Pharmacy Law | Physician Dispensing

As previously discussed in our April 2021 pharmacy alert, we have witnessed a growing trend in aberrant quantity audits and terminations coming from CVS Caremark. Specifically, CVS Caremark has been flagging more pharmacies for allegedly dispensing... Read More
Blogs & Articles | Community, Retail Pharmacies | Defending Pharmacies in PBM Audits | Life Sciences | Pharmacy Law

Lately, Frier Levitt has seen an increase in actions by pharmaceutical manufacturers (and their vendors) against pharmacies related to the use of certain patient-savings programs, such copay coupon programs.  The programs are designed to reduce... Read More
Blogs & Articles | Community, Retail Pharmacies | Life Sciences | Manufacturers | Pharmacy Law

PBMs are notorious for auditing pharmacies with the intent of seeking large recoveries, including a clawback of the entire reimbursement amount paid on a prescription claim in addition to an audit fee proportionate to the recovery amount. Audits... Read More
Blogs & Articles | Community, Retail Pharmacies | Defending Pharmacies in PBM Audits | Life Sciences | News & Press | Pharmacy Law

Pharmacy Benefit Managers (“PBMs”) utilize audits to monitor a pharmacy’s performance and recover any payments made improperly to pharmacies. While the stated purpose is to ensure that pharmacies are in compliance with a particular PBM’s... Read More
Blogs & Articles | Community, Retail Pharmacies | Defending Pharmacies in PBM Audits | Life Sciences | Pharmacy Law

Frier Levitt has reported in the past about Rochester Drug Cooperative (“RDC”), including how its guilty plea with the federal government for its role in the opioid crisis demonstrated major compliance failures from which other pharmacies should... Read More
Blogs & Articles | Community, Retail Pharmacies | Defending Pharmacies in PBM Audits | Life Sciences | Pharmacy Law

This past month, an office worker within a Jersey City doctor’s office pled guilty to healthcare fraud, admitting to receiving approximately $219,000 in kickbacks from a pharmacy in exchange for helping to route prescriptions to the pharmacy’s... Read More
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