This article examines Pharmacy Benefit Manager’s (“PBM”) “rebate walls” and the impact on the United States drug supply chain.  The Federal Trade Commission head, Commissioner Rohit Chopra, recently issued a report on PBM rebate walls,... Read More
Blogs & Articles | Community, Retail Pharmacies | Defending Pharmacies in PBM Audits | Life Sciences | Pharmacy Law | Plan Sponsor PBM Contract Services

The “law” applicable to drug reimbursement encompasses an array of laws across 50 states, the territories, and the federal government. These laws and regulations determine what a “Plan Sponsor” (such as an insurance plan, State Medicaid... Read More
Blogs & Articles | Community, Retail Pharmacies | Life Sciences | Maximum Allowable Cost Pricing & Appeals | Medicare, Medicaid, and Other Commercial Payor Audits & Appeals | News & Press | Pharmacy Law | Plan Sponsor PBM Contract Services

One of the most challenging issues for independent pharmacies throughout the United States is the issue of pharmacy benefit managers’ (PBMs) reimbursement practices. There are numerous ways in which PBMs dictate reimbursement to independent... Read More
Blogs & Articles | Defending Pharmacies in PBM Audits | Life Sciences | Pharmacy Law | Plan Sponsor PBM Contract Services | Specialty Pharmacies

Pharmacy Benefit Managers (“PBMs”) have developed a perverse technique to incentivize pharmacies to dispense more expensive brands, at the expense of Plan Sponsors and patients.  Plan Sponsors seek to reduce their drug spend by encouraging the... Read More
Blogs & Articles | Defending Pharmacies in PBM Audits | Pharmacy Law | Plan Sponsor PBM Contract Services

In September 2018, New Jersey Governor Phil Murphy announced that the State of New Jersey awarded the PBM contract to OptumRx and agreed to pay OptumRx $6.7 billion over three years to manage and administer pharmacy benefits for the State. Under New... Read More
Blogs & Articles | Defending Pharmacies in PBM Audits | Pharmacy Law | Plan Sponsor PBM Contract Services

PBMs market themselves as “transparent” and purport to “pass through” all rebates to Plan Sponsors. However, recent litigation has brought that into question. We have seen alarming instances where PBMs secretly use little-known Rebate... Read More
Blogs & Articles | Defending Pharmacies in PBM Audits | Pharmacy Law | Plan Sponsor PBM Contract Services

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
Blogs & Articles | COVID-19 Resources | Defending Pharmacies in PBM Audits | Pharmacy Law | Plan Sponsor PBM Contract Services

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
Blogs & Articles | Defending Pharmacies in PBM Audits | Pharmacy Law | Plan Sponsor PBM Contract Services