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 …
Category Archives: Firm News
PBM Updates Aberrant Product List
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 …
Boesen & Snow Law Successfully Overturns $1,000,000 in PBM Audit Findings for Specialty Pharmacy Client
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, …
Compounders prevail: Federal judge rules against FDA in MOU lawsuit
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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PBM’s Continue Fight Against State Regulation
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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Supreme Court Victory for States and Independent Pharmacies
With the national conversation discussing a Supreme Court of the United States (SCOTUS) that is often highly politicized and characterized as divided, it should be comforting to the independent pharmacy community to know that SCOTUS issued a unanimous, 8-0 (Justice Barrett did not participate in this decision) decision in the case of Rutledge v. PCMA. …
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Boesen & Snow Law Successfully Contests Generic Effective Rate Clawback in Excess of $300,000.
Boesen & Snow Law recently assisted an independent pharmacy facing a significant clawback in excess of $300,000 related to a Generic Effective Rate Reimbursement true-up by their PSAO on behalf of a major PBM. Boesen & Snow was able to contest the clawback on behalf of the client and after reviewing the specifics of the …
Buying a pharmacy is major undertaking legally and otherwise
Buying an existing pharmacy is usually easier and less expensive than starting one from scratch, assuming you do the right planning, of course. But if you are already familiar with the pharmacy business, you know it will be simple. Early on, you will want to assemble a team to advise you on tentative research to …
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Telehealth services and medical malpractice issues in Arizona
In April 2018, Arizona Governor Doug Ducey signed a bill into law that expanded insurance coverage to include telehealth services such as remote patient monitoring. Almost all large employers offer these services to their workers when they are available, but eliminating face-to-face meetings with doctors has raised concerns among doctors and medical malpractice insurers. Research …
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The Arizona Pharmacist’s Right to Refuse to Participate in Care
In Arizona, state law says that a pharmacist doesn’t have to fill a prescription for medication that can help with an abortion or a similar procedure. Furthermore, an individual cannot have a professional license revoked if he or she acts in accordance with a religious belief. According to the Arizona State Board of Pharmacy, denying …
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