Pharmacies, Pharmacy Benefit Admin. & Medicare Part D

Our attorneys have counseled pharmacies and pharmacy benefit management (PBM) companies since the early 1990s. Firm attorneys also counsel health plans and insurers in the development of their pharmacy benefit programs and in their contracting with PBMs. We have worked extensively with both health plan and PBM clients as they organize and execute their Medicare Part D prescription drug programs and navigate through the Final Rule implementing Part D of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA). Our attorneys have experience with the following:

Pharmacy Representation

• Retail and mail service pharmacy licensure
• Regulatory compliance
• Contracting models and negotiation

Pharmacy Benefit Administration for Health Plans and PBMs

• Contracts between PBMs and funded and self-funded clients
• PBM contracting with network pharmacies
• PBM contracting for rebates and other drug company incentives
• PBM licensure and risk management
• State and Medicare managed care regulatory compliance
• HIPAA privacy and security
• Analysis of PBM rebate and administrative fee retention
• Fraud and abuse
• Medi-Cal and Medicaid best pricing
• ERISA fiduciary duty and disclosure requirements
• Drug discount cards

Medicare Part D Prescription Drug Program

• Compliance with MMA and Medicare Part D regulations
• Assistance with Medicare Part D applications
• Assistance with joint enterprise applications
• Seeking CMS guidance on specific prescription drug program issues
• Development and negotiation of standard operating contracts
• Administrative services and support arrangements
• Sales and marketing guidance and arrangements