Health (Pharmacy Benefit Management)

 

• Consultation for pharmacy benefit manager and other providers of various pharmacy benefit administration services or support (collectively, PBMs) in transactions with various branded and generic pharmaceutical producers, healthcare providers and vendors, regional healthcare systems and healthcare-related plans, such as commercial, Federal Employees Health Benefits Program (FEHBP), indemnity health insurers, managed care organizations (MCOs), Medicaid, Medicare Advantage and Part D, pharmacies, prepaid health plans, self-insured employers, state employee plans, Taft-Hartley medical plans, third-party administrators (TPAs), unions, workers' compensation insurers.

 

• General PBM-related issues, such as affiliations, auto-dispensing, bid evaluation, contracts (such as master drug purchasing), construction, corporate governance, cybersecurity, data privacy, drug recalls, e-prescribing, electronic medical records (EMR) retention, employment, financing, individual and institutional enrollment and licensure, infusion services, immunization services, investigations, leases, limited and wholesale distribution, mail-order drugs, M&A and collaboration agreements, marketing, outsourcing, payments (such as through co-payment cards, coupons, patient assistance, rebates and rewards), payer certifications and reimbursement (involving Medicare, Medicaid and private payers), pricing, procurement, promotions, real estate, representations, RFPs, RFQs, risk analysis and management, sales, supply chain (agreements for products and related services), telemedicine.

 

• Consultation regarding the role of PBMs in deciding how much pharmacies will be reimbursed for the drugs they sell, determining what drugs are covered in their formularies, determining which pharmacies will be included in prescription plans, negotiating prices for these drugs with their manufacturers, and setting copays for consumers.

​

    Last updated 210509_1602