PBMs – Duane Morris Life Sciences Law

September 3, 2024 by Duane Morris

House Oversight Committee Gives Pharmacy Benefit Managers Deadline to Correct Congressional Record of Allegedly Fraudulent Statements

On August 28, 2024, the U.S. House Committee on Oversight and Accountability issued letters to executives of three of the nation’s largest pharmacy benefit managers (PBMs), accusing them of providing false testimony before Congress. Each letter outlines the allegedly false statements and the evidence that the statements contradict. They also outline the statutory penalties for perjury before Congress—namely, monetary fines and imprisonment for up to five years. The letters give the PBMs until September 11, 2024, to correct the Congressional Record.

Read the Alert on the Duane Morris LLP website.

February 28, 2024February 28, 2024 by Duane Morris

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. […]

Continue reading “Community Pharmacists Demand CMS Take Enforcement Action Against PBMs”

December 7, 2020 by Duane Morris

PBMs Must Say Goodbye to Manufacturer Rebates

Pharmacy benefit managers (PBMs) play a significant role in U.S. drug pricing, yet their existence is little known to those outside of the pharmaceutical and insurance arenas. In an effort to modify one of the largest drivers in increasing drug costs―rebates paid to PBMs by drug manufacturers―the U.S. Department of Health and Human Services on November 20, 2020, published three final rules that, most notably, declared that these rebates are no longer protected by the safe harbors to the anti-kickback statute.

To read the full text of this Duane Morris Alert, please visit the firm website.