Feb 19, 2024 | Drug costs, Drugmakers, Generic Drugs, Lawsuits, Pharmacy Benefits Manager (PBM)
Leading drug manufacturer Johnson & Johnson is being sued for mismanagement of the company’s pharmacy plan. The lawsuit, which also names J&J’s pharmacy benefits manager (PBM) as a defendant, accuses the company of massively overpaying the PBM for...
Aug 4, 2023 | Algorithms, Forensic claims review, Lawsuits, Self-funding
In claims progressing, algorithms – mathematical formulas used to scrutinize particular elements of a claim form – can be good when used to ensure the accuracy and consistency of claim payments… but bad when used as a tool to deny claims. In a class action...
Apr 3, 2023 | Lawsuits, News, Ohio, Pharmacy Benefits Manager (PBM), Prescription, Regulatory, State legislation
Ohio Attorney General David Yost has sued pharmacy benefit managers (PBMs) Express Scripts and Prime Therapeutics for conspiring to illegally increase prescription drug prices and force pharmacies to accept low reimbursement rates. Cigna Group and Humana were also...
Feb 15, 2023 | Compliance, Independent Dispute Resolution (IDR), Lawsuits, News, No Surprises Act (NSA), Regulatory
Independent Dispute Resolution (IDR) review decisions have been placed on hold due to a lawsuit brought forth by the Texas Medical Association (TMA). The lawsuit challenges the Final Rules of the No Surprises Act, specifically those relating to how the Qualified...
