Supreme Court Rules Against Pharmacy Benefit Managers, Scoring a Win for Independent Pharmacies

A judge 's gavel and pills on the table.

The U.S. Supreme Court recently ruled against Pharmacy Benefit Managers (PBMs), scoring a win for smaller, independent pharmacies. The opinion by the high court will allow states to regulate how much money PBMs are required to reimburse pharmacies for prescription medication. On December 10, 2020, in Rutledge v. Pharmaceutical Care Management Assn., the Supreme Court…

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Pharma Giant Pays $22M to Settle Alleged Kickback Scheme Involving Charitable Foundations

A keyboard with the word " kickback !" written on it.

Pharma giant Biogen Inc. has become the most recent company to resolve allegations that it violated the False Claims Act by illegally using two charities to pay the co-pays of Medicare patients taking its multiple sclerosis drugs, Avonex and Tysabri. The U.S. Department of Justice announced earlier this month that the Cambridge, Mass.-based company agreed…

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HHS Proposes Revisions to HIPAA Privacy Rule

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The U.S. Department of Health and Human Services Office for Civil Rights (OCR) is seeking to revise the HIPAA Privacy Rule, a move it says will “remove barriers to coordinated care, and reduce regulatory burdens on the health care industry.†The proposed rule changes are part of HHS’ “Regulatory Sprint to Coordinated Care.†Among some…

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HHS, CMS Announce Changes to Stark Law and Anti-Kickback Statute

A doctor is handing money to another person.

The U.S. Department of Health and Human Services Office of Inspector General and Centers for Medicare & Medicaid Services recently published long-awaited final rules that significantly reform regulations interpreting the federal Stark Law and Anti-Kickback Statute. The agencies have stated that the changes “aim to reduce regulatory barriers to care coordination and accelerate the transformation…

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