Effective January 1, 2022, at least one of the major PBMs has updated language related to the billing of specific NDC numbers the PBM considers “Aberrant.” The revised list of NDCs was sent to network pharmacies and includes a list of “Practices and Trends” prohibiting dispensing activities. The revised language, while vague, creates multiple pitfalls …
Beginning on December 15, 2021, a major PSAO’s network of pharmacies will no longer be part of TRICARE’s pharmacy network, which is managed by Express Scripts, due to a contract dispute between TRICARE and the PSAO. TRICARE members currently receiving prescriptions from affected Pharmacies have already received notification from TRICARE of the upcoming change. If …
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Boesen and Snow successfully assisted an independent specialty pharmacy appeal the findings of a major PBMs desktop audit. The preliminary audit consisted of over $1,000,000 in discrepancies, most of which the PBM considered unappealable. Boesen and Snow utilized a multifaceted argument to appeal the “unappealable” claims including a unique presentation of prescription documentation, prescriber statements, …
Pharmacies to Terminate from TRICARE Networks Effective December 15, 2021. Beginning on December 15, 2021, a major PSAO’s network of pharmacies will no longer be part of TRICARE’s pharmacy network, which is managed by Express Scripts, due to a contract dispute between TRICARE and the PSAO. TRICARE members currently receiving prescriptions from affected Pharmacies have …
FROM APC: Judge rules in favor of compounders, against FDA in lawsuit over MOU A federal district court judge has issued a summary judgment<https://a4pc.org/files/2021-09-21_MOU-Order.pdf> in favor of a group of compounding pharmacies, ruling that FDA’s MOU on interstate shipments of compounded drugs violated the law, and the agency cannot enforce it. The MOU will be …
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With the flu season around the corner and understanding that health risks may increase for people who contract seasonal influenza at the same time as COVID-19, vaccination is the best way for most people to protect themselves against COVID-19 and seasonal flu. To ensure people can get vaccinated easily, HHS Secretary Becerra took action to …
Pharmacy Benefit Managers (PBMs) are continuing to fight against state regulation. On Tuesday, the Pharmaceutical Care Management Association (PCMA) filed a new brief with the Eighth Circuit Court of Appeals in opposition to North Dakota Century Code sections 16.1 and 16.2. In 2017, the North Dakota passed legislation to regulate PBM practices including limiting the …
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Prop 207: Can My Marijuana Conviction be Expunged in Arizona? In November of 2020, the citizens of Arizona voted to approve Proposition 207 which legalized private, recreational cannabis use. Proposition 207 also included provisions in which people with certain marijuana criminal charges could petition the court to get the convictions expunged from their records. Having …
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Purchasing your own pharmacy can be wonderful opportunity to flex your entrepreneurial muscles, while providing the best for your patients. Indeed, the notion of being your own boss, being able to practice pharmacy in the way that you think is best, and increasing your earning potential are all good, sound reasons to consider buying your …
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PBM Audits commonly review prescription hard copies, signature/delivery logs, drug invoice purchases, proof of copayment collection, proof of prescriber/patient relationship, patient consent to fill, and non-resident state licensure. PBM Audits are just one of the many hurdles your pharmacy will inevitably face while you strive to serve patients. Poor audit findings lead to extensive financial …