Healthcare has become increasingly regulated. The pharmacy benefit and specialty pharmacy industry is governed by numerous federal and state laws and regulations, and consent orders. Other government sub-regulatory guidance provides further pressure on the industry to conform with government expected “best practices”. Health plans, discount card sponsors, pharmacy benefit managers, pharmacies, manufacturers, data companies, and consultants servicing industry players need to understand the legal and regulatory framework within which they operate. The specific areas we assist our clients with include:
AREAS OF EXPERTISE
- Fraud, Waste, and Abuse
- HIPAA/HITECH
- Patient Privacy
- Medicare Part D
- Dual Eligible Programs
- Prompt Pay
- Any Willing Provider
- Pharmacy Operations
- Clinical Programs
- Provider Contracting Requirements
- Discount Card Programs
- 340B Programs
- PBM Service Agreements
- Pharmacy Network Agreements
- Rebate Agreements
- Manufacturer Service Agreements
- Drug Purchase Agreements
- Data Use/Sales
- Software License/Purchase Agreements
- Distribution and Vendor Agreements
- PBM
- TPA
- UR
- PPO
- Mail Order
- PBM/Health Plan
- PBM/Discount Card
- Breach of Contract
- Contractual Interference
- Government Investigations, inquiries, and proceedings
- Pharmacy and/or Plan Payment Issues
- Pharmacy Audits
- Pharmacy Terminations