Pharmacy Benefit Management

Hall Render attorneys have diverse and extensive experience counseling pharmacies, providers, health plans and pharmacy benefit managers (“PBMs”) on issues related to pharmacy benefit management. In carrying out these services, our attorneys assist clients in developing and negotiating complex pharmacy benefit management and pharmacy services agreements, group purchasing organization arrangements and drug rebate contracts. We work closely with clients to address regulatory and compliance issues related to participation in Medicare Advantage and Medicare Part D, including requirements applicable to health plans, pharmacies, PBMs and other first tier, downstream and related entities.

Our team includes attorneys who have previously served as in-house counsel for large health plans and PBMs. We leverage this experience to provide our clients with sophisticated advice related to negotiating and managing relationships with PBMs, including advising on drug pricing, reimbursement and billing matters; analyzing legal issues related to PBM-driven medication adherence and therapeutic interchange programs; establishing prescription drug discount programs; advising on state PBM, third party administrator and prescription drug discount card licensure requirements; and providing practical counsel on fraud and abuse and HIPAA privacy matters.