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New York Enacts PBM Licensing and Oversight Laws

On January 2, 2022, New York Governor Kathy Hochul announced the signing of legislation S.3762/A.1396 that seeks to regulate pharmacy benefit managers (“PBM”). PBMs doing business in New York must immediately register with the Superintendent of Insurance, be licensed by the Department of Financial Services by 2022 and renew their licenses every three years. The …

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, …

Looking to Buy a Pharmacy? Be Sure to Do Your Due Diligence

Purchasing your own pharmacy can be wonderful opportunity to flex your entrepreneurial muscles, while providing the best for your patients.  Indeed, the notion of being your own boss, being able to practice pharmacy in the way that you think is best, and increasing your earning potential are all good, sound reasons to consider buying your …

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 …

Signature Log Audits: Are you Maintaining the Proper Documentation for In-Person and Mail-Delivered Prescriptions?

Many PBMs relaxed the requirements on signature logs for both in person and delivered medications due to the Covid-19 Pandemic. Some PBMs even allowed mailed prescriptions when otherwise prohibited. While the ease in restrictions made providing patients with their medications easier, the PBMs retained the right to audit signature logs regardless of the lifted restrictions. …

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 …

Lawmakers, providers and patients review HIPAA and HITECH’s legacy

HIPAA is almost 25 years old, and articles have begun looking at its impact. Lawmakers first enacted the landmark law in 1996, the year before the invention of the DVD. Aiming for security and privacy in U.S. health care, HIPAA began in the era of mostly paper records. Later updates, especially HITECH (Health Information Technology …

Safe handling of hazardous drugs takes more than rules

Pharmacies and the rest of the health system are still meeting and adjusting to the changes brought by USP 800. Not meeting its standards for handling hazardous drugs can pose medical risks for patients and staff as well as professional and legal risks. But a recent review article in Pharmacy Practice News highlights the ways compliance can …

Regulations for pharmacies to watch in 2020

Health care companies often find it challenging to stay ahead of the various trends across their sector. As both third-party entities and the federal government look at making changes that could impact the drug industry, there are some updates the pharmaceutical industry may want to focus their attention on. Standards for new laws and policies These …

Court says man can sue for pharmacist’s joke

The Arizona Court of Appeals has decided that a national chain of pharmacies can face a lawsuit after one of its pharmacists joked with a man’s ex-wife about a prescription for erectile dysfunction drugs. The lawsuit was dismissed by the trial court and the man’s attorney appealed; the Court of Appeals brought parts of the …