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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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.

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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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