Boesen and Snow recently secured the reversal of a major PBM’s decision to terminate a pharmacy from its network. Before the reversal, the PBM had rejected the pharmacy’s documentation refuting the audit findings and had quickly issued its termination letter. Boesen and Snow collaborated with the pharmacy client to obtain and provide overwhelming evidence to …
Continue reading “Boesen and Snow Successfully Appeals PBM Network Termination.”
On July 22, 2022, the FDA announced a proposed rule changing the current 10-digit NDC format to a 12-digit standardized format. This is due to the limited number of new 5-digit Labeler Codes estimated to run out in the next 10 to 15 years. Current regulations require a 5-digit Labeler Code, 3 to 4-digit Product …
Last week, President Biden issued an Executive Order (“Order”) on protecting access to reproductive healthcare services. Part of the Order called upon the Department of Health and Human Service (“HHS”) to identify potential actions to protect and expand access to reproductive healthcare services through outreach, education, promote awareness, and steps to ensure patients receive protections …
Has something changed in your life? Have you moved? Did you change jobs? Did you sell all or part of your business or hire a new licensee? If the answer is yes, the regulatory agency that issued your professional license probably wants to know about it. Address of Record Professional regulatory agencies generally require licensees …
Continue reading “The Importance of Licensees Updating Regulatory Agencies of Certain Events”
CMS recently published “Contract Year 2023 Policy and Technical Changes to the Medicare Advantage and Medicare Prescription Drug Benefit Programs; etc,”, effectively ending the retroactive application of direct and indirect renumeration (DIR) fees by Prescription Benefit Managers (PBM’s). DIR fees will now be required to be included in the negotiated price the patient pays at the …
Continue reading “CMS Final Rule Phases Out PBM’s Ability to Retroactively Apply DIR Fees”
The regulatory landscape across the United States changed dramatically Friday as Dobbs v. Jackson Women’s Health Organization overturned the nearly five-decade precedent set by Roe V. Wade. In Dobbs, the United State Supreme Court held that abortion is not a constitutional right and should instead be regulated at the discretion of the individual states. The decision was met …
Continue reading “Uncertainty Looms Following Supreme Court’s Overturning of Roe v. Wade”
Both federal and state authorities are increasing the scrutiny and regulation of Pharmacy Benefit Managers (“PBMs”). In the U.S. Senate, Senator Chuck Grassley (R – Iowa) and Senator Maria Cantwell (D – Washington) have sponsored the Pharmacy Benefit Manager Transparency Act of 2022. The bipartisan bill would empower the Federal Trade Commission to increase drug …
Continue reading “Scrutiny of PBMs Continue (And It’s About Time)…”
On June 7, 2022, in a unanimous 5-0 vote, The US Federal Trade Commission reversed a previous 2-2 deadlock vote that will result in the commissions probe of pharmacy benefit managers including the top six PBMs; CVS Caremark, Express Scripts, Inc. OptumRx, Inc., Humana Inc., Prime Therapeutics LLC and MedImpact Healthcare Systems, Inc. After the …
Boesen & Snow recently participated as co-counsel for a pharmacy that was the subject of a Board of Pharmacy complaint related to delivering pandemic related, patient-specific medication orders written pursuant to a telemedicine encounter. The concern of the Board of Pharmacy was whether the prescription orders were issued pursuant to a prescription order by a …
Boesen and Snow Law has observed an increasing number of PBM audits containing “Member Denied” claims including: Member Denied Paying Copayment Member Denied Receiving Medication Member Denied Requesting Medication The trend has shown that currently, Member Denials can be nearly impossible to overcome despite refuting evidence and have increasingly led to the termination of Pharmacies’ …