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 …
Category Archives: Pharmacy & Health Professions Law
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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Board of Pharmacy Investigations: How Your PBM Audit May Put You in Hot Water with The State Boards of Pharmacy
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 …
Patient Copayments and the Use of Manufacturer Coupons
How Saving a Patient Money can Cost Your Pharmacy the Entire Paid Claim Amount or Worse, Your Pharmacy’s PBM Contract. Most who have worked in a pharmacy for some time can remember the Purple Pill Card, the Nexium Savings Coupon with the catchy name and bright purple colors. Not only did this program have catchy …
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PBM Aberrant Product Lists: The Aberrant NDC and Percentage Billed Compared to Total Volume is Only Part of the Issue
Billing of Aberrant NDCs Beginning in January of 2020, at least one of the major PBMs began monitoring its network pharmacies for the billing of specific NDC numbers the PBM considered “Aberrant”. The list of NDCs was sent to network pharmacies in November of 2019 and has since been updated in November of 2020. The …
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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What medical professionals should know about liability during a pandemic
The past weeks have left medical providers and health care professionals at risk in more ways than one. In addition to their exposure to contagion, our vital workers may be left exposed legally. Currently, medical providers are working under a patchwork of protections. The result? Ongoing uncertainty and potential for catastrophic and expensive legal suits. …
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BOESEN & SNOW HEALTH LAW SOLUTIONS FOR COVID-19 MATTERS
www.covid19lawfirm.com Boesen & Snow is working with our clients regarding common pharmaceutical supply chain questions, pharmacy operations issues, and business continuity plans related to COVID-19. Please contact our attorneys about COVID-19 and your legal issues. Matters with which we are already engaged include: Properly documenting the usage of override codes for emergency fills (overuse will …
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What counts as a patient information breach?
Arizona saw nearly 80,000 patient records breached in the first half of 2019 alone. Despite everything health care professionals do to lock up patient information, some experts say data safety is in crisis. In the future, more people will likely get all the information they need when they need it. But more points of access …
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