Pharmacy Benefit Managers (PBMs) Maximum Allowable Cost or “MAC” pricing continues to be one of the most challenging issues facing independent pharmacies throughout the United States—MAC is one of the primary ways in which PBMs reimburse... Read More
On May 19, 2020, the Department of Health and Human Services (HHS) issued guidance clarifying whether the Public Readiness and Emergency Preparedness (PREP) Act preempts State licensing laws that restrict pharmacists and pharmacies from ordering and... Read More
Frier Levitt recently helped a Utah-based independent pharmacy who was facing a Fraud, Waste and Abuse audit conducted by a PBM and successfully reduced the audit chargeback from over $1.4M to a little over $800. The PBM alleged that the Pharmacy... Read More
Plan Sponsors, ranging from self-insured employers to government entities, have taken steps to relax requirements so that patients have access to healthcare and life saving drugs. However, some PBMs have taken the opportunity to syphon money out of... Read More
Click here to view our June 2020 issue of Plan Sponsor News! This publication is designed to help large employers, union groups and self-insured companies understand their drug benefit design. In this issue, you'll read about: The Impact of... Read More
At the end of 2019, Prime Therapeutics, LLC (“Prime”) announced that it had entered into a three-year supply chain agreement with Express Scripts, Inc. (“ESI”) “to focus on enhancing pharmacy networks and pharmaceutical manufacturer... Read More
Frier Levitt has noticed a recent uptick in pharmacies experiencing issues with not consistently receiving payments from certain PBMs – including OptumRx – on clean claims. This could involve untimely payments, unreconciled payments or payments... Read More
At the request of the Defense Health Agency (“DHA”), Express Scripts, Inc. (“ESI”) has begun sending letters to some of the pharmacies within its network recouping on claims that had been submitted to TRICARE. This recent batch of letters is... Read More
In an effort to facilitate continuity of patient care and to respond appropriately to the circumstances that have arisen during the COVID-19 pandemic, the Drug Enforcement Administration (“DEA”) has recently announced three exceptions to DEA... Read More
In December 2019, we learned that Prime Therapeutics, LLC (“Prime”) and Express Scripts sought to begin a massive collaborative effort that would cover over 100 million Americans and was “designed to deliver more affordable care for clients... Read More
