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Pharmacy Benefit Manager (PBM) Audits

Hall Benefits Law

How Plan Sponsors Can Mitigate Risk in PBM Contracts

Hall Benefits Law on

For employers offering benefit plans, fiduciary responsibility is not just a legal designation. Under the Employee Retirement Income Security Act of 1974, as amended, the fiduciary duty is the highest standard of care...more

Mintz - Health Care Viewpoints

EnforceMintz — Medicare Advantage and Part D Programs to Remain in the Enforcement Spotlight in 2025

As government scrutiny and enforcement targeting the Medicare Advantage (Medicare Part C) program continued in 2024, the industry’s response to agency actions escalated. Last year also resulted in the first sizable Part D...more

Mintz - Health Care Viewpoints

PBM Policy and Legislative Update — Fall 2024

Mintz’s PBM practice is pleased to present its quarterly publication, PBM Policy and Legislative Update. This edition builds upon prior issues and summarizes activity from July through September that affects the PBM industry....more

Foley & Lardner LLP

Health Policy: Expected Movements in the Lame Duck Session – November/December 2024

Foley & Lardner LLP on

Congress returned to Washington this week with just five weeks left in this year’s legislative calendar. With a Continuing Resolution (CR) that expires December 20, 2024, either a year-end spending package or a new Continuing...more

Proskauer - Health Care Law Brief

NYS DFS Revisits PBM Regulation with Scaled-Back Draft Rules

On February 6, 2024, the New York State Department of Financial Services (“DFS”) released “pre-proposed” consolidated rulemaking related to the business practices of Pharmacy Benefit Managers (“PBMs”) licensed to operate in...more

Oberheiden P.C.

10 Keys to Successful Pharmacy Audit Appeals

Oberheiden P.C. on

Government agency audits focused on Medicare, Medicaid, and pharmacy benefit manager (PBM) compliance can result in substantial losses for pharmacies. Each pharmacy is audited the same way it is done with other similarly...more

Oberheiden P.C.

PBM Audit Defense: Key Strategies for Pharmacies in 2025

Oberheiden P.C. on

Pharmacy benefit managers (PBM) audits are becoming increasingly dangerous for independent pharmacies. While the role of the PBM was initially to reduce costs for all parties involved, abusive PBM practices have led to the...more

Latham & Watkins LLP

Healthcare & Life Sciences: Drug Pricing Digest - June 2021

Latham & Watkins LLP on

Biden Releases Federal Budget Proposal for 2022: On May 28, 2021, President Biden released the proposed budget for fiscal year 2022, which would increase health spending by 23%. The proposal urges Congress to enact drug...more

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