Community Pharmacists Demand CMS Take Enforcement Action Against PBMs

As news surfaced on February 27 that Congress is punting long-debated pharmacy benefit manager reforms, the community pharmacy lobby demanded CMS immediately take enforcement action against improper PBM practices that the lobby says could cause nearly a third of independent pharmacies to shutter this year. […]

Jonathan Swichar, partner and chair of Duane Morris’ Pharmacy Litigation Group, alleged denying reimbursement and reimbursing at below cost is a tactic used by PBMs to hurt independent pharmacies.

“It’s one of the many initiatives employed by pharmacy benefit managers of the past 10 years to eliminate the competition independent pharmacies pose to their own affiliate pharmacies,” he said. […]

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CMS Issues Proposed Regulations to Expand Open Payments System Reporting

In the Federal Register posted on August 14, 2019, the Centers for Medicare and Medicaid Services (CMS) published proposed regulations that, if finalized, would expand the Open Payments reporting requirements initially introduced under the Physician Payments Sunshine Act. The Open Payments program sheds light on some of the payments (and other transfers of value) made from certain drug, device, biologicals and medical supply manufacturers to covered recipient physicians and teaching hospitals. Under the Physician Payments Sunshine Act, the applicable manufacturers must report certain payments made to the covered recipients through the Open Payments program on an annual basis. Such disclosures are available to the public. The categories of payments or transfers of value that must be disclosed include: research, honoraria, gifts, grants, travel expenses, and marketing, education or research for a specific covered drug or device.

View the full Alert on the Duane Morris LLP website.

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The opinions expressed on this blog are those of the author and are not to be construed as legal advice.

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