It is not uncommon for pharmacies to apply manufacturer’s coupons to assist patients with high deductibles. But when applied incorrectly, the pharmacy may face recoupments, audits/investigations, and large settlements as recent cases illustrate.
The U.S. Attorney’s Office has recently reached a $3.5 million settlement with specialty pharmacy Advanced Care Scripts, Inc. (ACS), to resolve allegations
Since the inception of the 340b program, drug manufacturers have been attempting to curtail it to avoid offering discounts or to prevent double discounts (which occurs when a 340b drug is billed to a Medicaid program). This year, however, there were multiple coordinated attempts by manufacturers to exit the program. For example:
Recently, we have seen many cases filed by whistleblowers against pharmacies for not properly reporting their Usual-and-Customary Drug Prices (U&C). The cases are usually filed under the False Claims Act (FCA) for manipulating U&C to receive greater reimbursements from government payors.
First of all, what is U&C? There is no uniform definition. Instead, third-party payor
As prescription drug spending continues to increase, governments continue to scrutinize arrangements between pharmaceutical companies, healthcare providers, assistance programs, and patients. For example, recently, two non-profit foundations – Chronic Disease Fund, Inc. (“CDF”) and Patient Access Network Foundation (“PANF”) – have agreed to pay $2 million and $4 million, respectively, to resolve allegations that they
A recent report released by California health officials revealed that drug prices are still on the rise – even despite California’s drug-price transparency laws aimed at curbing drug cost.
In 2017, California passed a drug-price transparency law that requires manufacturers to notify its customers at least 60 days in advance if they plan to increase
The Medicare Modernization Act (2003) allows states to enact their own drug importation laws. The Act specifies that such laws would only be valid if the federal government reviewed and approved a state’s proposal to import prescription drugs. Despite the length of time since the passage of the Act, no state has enacted such law
Last month, California Governor signed the most comprehensive drug pricing transparency bill in the nation. SB-17 is intended to promote transparency in drug pricing, reduce overall healthcare spending, and shine light on how drugs are priced. Under the new law, drug manufacturers, PBMs, health plans, and insurers operating in California are required to report drug
Unlike most countries, the U.S. does not regulate drug pricing but allows the market to set them according to demand. On numerous occasions, the U.S. Congress sided with the pharmaceutical industry and failed to pass laws that would change how drugs are priced. In addition, the Trump administration has delayed the implementation of a rule
Biologics are the fastest growing and the most expensive class of drugs on the market. The current cost of biologics is between $50,000 to $250,000 for one year of treatment. FTC Press Release. The numbers are expected to increase even further. Congressional Research.
Biosimilars –on the other hand – are less expensive due