The Ins and Outs of PBMs

The Ins and Outs of PBMs

In a world where PBMs also operate their own in-house specialty pharmacies, the incentive to reduce competition has never been stronger. PBMs have used a variety of reasons to justify network termination, many of which are easily avoidable. But to do so requires knowledge by pharmacies, as well as swift and careful action when addressing audits, investigations and credentialing applications.

In this recorded webinar, Jesse C. Dresser, Esq. attorney and partner at Frier Levitt,  discusses how the inner working of PBMs, including:

  • Health plan structures and what they mean to pharmacies from a legal perspective
  • Competition between PBM-owned specialty pharmacies and health system-owned pharmacies
  • PBM activity in the 340B space
  • PBMs and Limited Distribution Drugs (LDDs)
  • NADAC pricing
  • DIR Fees

By the end of the presentation, participants will be able to:

  • Articulate examples of PBM credentialing frameworks and areas of potential pitfalls
  • Evaluate reimbursement rates/trends in different PBM programs and understand tools to combat them
  • Differentiate between appropriate terms and conditions for participation, and strategies for network access
  • Understand recourse options in dealing with improper 340B reimbursement

*presented in connection with Acentrus Specialty

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