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. …
Category Archives: Pharmacy & Health Professions Law
USP General Chapter Revisions for 795 and 797 Published Today (November 1, 2022)
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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PBM Audits Move Fast. Start Preparing Your Defense Today!
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 Successfully Appeals PBM Network Termination.
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 Final Rule Phases Out PBM’s Ability to Retroactively Apply DIR Fees
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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The Profound Responsibility of the Pharmacist When Filling Prescriptions for Patients Pursuant to a Telemedicine Encounter – Even in a Public Health Emergency
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 …
Shared Service Agreements in the Pharmacy Industry
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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PSAO’s network of pharmacies will no longer be part of TRICARE’s pharmacy network
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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PSAO TRICARE Dispute
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 …
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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