Articles and Blogs

pharmacy benefit managers

FTC Releases Second Interim Staff Report on Pharmacy Benefit Managers

[01/29/25]

Posted on January 29, 2025 in Health Law News

Published by: Hall Render

On January 14, the Federal Trade Commission (“FTC”) published its Second Interim Staff Report (“Report”) on pharmacy benefit managers (“PBMs”), focusing on PBM pricing practices for specialty generic drugs. The Report described significant markups of cancer, HIV and other chronic condition specialty drugs and high reimbursement rates paid by Caremark Rx, Express Scripts and... READ MORE

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Pressure on PBMs Intensifies as FTC Targets Top PBMs Over Insulin Rebates

[09/30/24]

Posted on September 30, 2024 in Health Law News

Published by: Hall Render

On September 20, 2024, the Federal Trade Commission (“FTC”) filed an administrative complaint against Caremark Rx, Express Scripts and OptumRx, and their affiliated group purchasing organizations (“GPOs”), for engaging in anticompetitive and unfair rebate practices resulting in the artificial inflation of insulin prices. The FTC alleged that by creating a system in which drug... READ MORE

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FTC Launches Inquiry into Pharmacy Benefit Managers: Is This Time Different?

[06/15/22]

Posted on June 15, 2022 in Health Law News

Published by: Hall Render

On June 7, 2022, the Federal Trade Commission (“FTC”) announced that it would launch an inquiry into the business practices of the nation’s six largest pharmacy benefit managers (“PBMs”). The inquiry will investigate the impact of vertically integrated PBMs on the access and affordability of prescription drugs. This news comes at a time when... READ MORE

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Open the Floodgates: U.S. Supreme Court Decides ERISA Does Not Preempt Arkansas State Law Regulating PBMs

[12/23/20]

Posted on December 23, 2020 in Health Law News

Published by: Hall Render

On December 10, 2020, the Supreme Court of the United States (the “Supreme Court”) unanimously overturned an Eighth Circuit decision in the case of Rutledge v. Pharmaceutical Care Management Association. In the case, the Supreme Court held that an Arkansas law known as Act 900, which regulates the rates at which pharmacy benefit managers... READ MORE

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OIG Finalizes Controversial Rule Updating AKS Discount Safe Harbor Applicable to Prescription Drug Rebates

[12/21/20]

Posted on December 21, 2020 in Health Law News

Published by: Hall Render

In the closing days of the Trump administration, OIG finalized a controversial rule (the “Final Rule”) to amend the discount safe harbor (“Discount Safe Harbor”) to the federal Anti-Kickback Statute (“AKS”), effectively changing the treatment of prescription drug rebates under the AKS. Beginning January 1, 2022,[1] certain reductions in price or other remuneration from... READ MORE

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Assessing the Impact of the New Drug Pricing Executive Orders

[07/31/20]

Posted on July 31, 2020 in Health Law News

Published by: Hall Render

On July 24, 2020, President Trump announced four Executive Orders (“Executive Orders”) characterized as focusing on lowering drug prices via various mechanisms. These Executive Orders, described in more detail below, include: (1) Executive Order on Access to Affordable Life-saving Medications; (2) Executive Order on Lowering Prices for Patients by Eliminating Kickbacks to Middlemen; (3)... READ MORE

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Informational Bulletin from CMS Addresses Best Practices to Avoid 340B Duplicate Discounts

[01/17/20]

Posted on January 17, 2020 in Health Law News

Published by: Hall Render

On January 8, 2020, the Centers for Medicare & Medicaid Services (“CMS”) released an Informational Bulletin titled “Best Practices for Avoiding 340B Duplicate Discounts in Medicaid” (“Bulletin”). The Bulletin outlines best practices that CMS encourages state Medicaid agencies to consider to avoid the situation where a manufacturer provides both a Medicaid drug rebate and... READ MORE

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Hall Render’s This Week in Washington – April 12, 2019

[04/12/19]

Posted on April 12, 2019 in Federal Advocacy

Published by: Hall Render

Congressional Leaders Discuss Health Care Priorities Congress’ top leaders, Senate Majority Leader Mitch McConnell (R-KY) and House Speaker Nancy Pelosi (D-CA), announced they are not embracing “Medicare for All” as a priority at the American Hospital Association’s annual Washington conference. Both leaders reinforced that each chamber will pursue largely separate health care agendas in... READ MORE

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Claims Denials Start April 1: What You Should Know About CMS’s New Preclusion List

[02/15/19]

Posted on February 15, 2019 in Health Law News

Published by: Hall Render

Beginning April 1, 2019, Medicare Part C and D plans, PACE organizations and 1876 cost contract plans (“Plans”) will be required to deny payment for services rendered or prescriptions ordered by any provider on the new Centers for Medicare & Medicaid Services (“CMS”) Preclusion List. The Preclusion List, which was first made available to... READ MORE

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Discount Disruption: PBM Rebate Protection May Be Removed, New Safe Harbors Combat Increasing Drug Costs

[02/01/19]

Posted on February 1, 2019 in Health Law News

Published by: Hall Render

On January 31, 2019, the Department of Health and Human Services Office of Inspector General (“OIG”) issued a proposed rule that, if finalized, would eliminate Anti-Kickback Statute (“AKS”) safe harbor protection for prescription drug rebates paid by manufacturers to pharmacy benefit managers (“PBMs”), Medicare Part D plans and Medicaid managed care organizations (“Proposed Rule”).... READ MORE

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