In the world of Pharmacy Benefit Manager (PBM) enrollment, guilt by association is one of the most common reasons PBM’s deny new pharmacy owners network access. Boesen & Snow often represents new clients who come to the firm with PBM enrollment denials due to alleged common associations with persons or entities with significant audit findings …
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Novo Nordisk filed lawsuits against multiple med-spas that are distributing compounded versions of Semaglutide. Semaglutide is the main ingredient in Ozempic, Wegovy, and Rybelsus—popular weight-loss medications. Their popularity resulted in nationwide shortages and the FDA listing Ozempic and Wegovy on the shortage list. Under certain conditions, compounding facilities can manufacture drugs identical, or near identical, …
Independent pharmacies and other small healthcare businesses are often at a disadvantage when competing with large pharmacy chains and businesses. Larger chains can leverage their size to secure substantial discounts from manufacturers and suppliers not available to smaller businesses. However, tools such as Group Purchasing Organizations (GPOs) can help small businesses level the playing field. …
The much anticipated USP General Chapter revisions for non-sterile and sterile compounding were published today. New and Updated Notices | USP-NF (uspnf.com) Please let us know if you need our firm of pharmacists, attorneys, and pharmacist-attorney to help your organization understand not just what the changes are, but more specifically how these will affect your …
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Don’t Wait! Build a relationship with an Experienced Pharmacy Law Team One of the more stressful parts of going through Pharmacy Benefit Manager (PBM) audit is that, by the time the average pharmacy hires experienced pharmacy law attorneys to defend their business, there may only be two weeks or less to formulate a successful response. …
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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 …
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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 …
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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 …
The last decade has seen a rise of so-called “shared service agreements” (“SSA’s”) within the pharmacy industry. These agreements, utilized by pharmacies under common ownership and pursuant to a contract between pharmacies that are not under common ownership, enable pharmacies to work with each other to perform certain prescription dispensing tasks. For example, one pharmacy …
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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 …
Continue reading “PSAO’s network of pharmacies will no longer be part of TRICARE’s pharmacy network”