Author: Peter

This week, a federal judge in Greeneville, Tennessee, sentenced seven individuals and seven related corporate entities for their roles in a multimillion-dollar health care fraud scheme...Peter Bolos and his co-conspirators, Michael Palso, Andrew Assad, Scott Roix, Larry Smith, Mihir Taneja, Arun Kapoor and Maikel Bolos...deceived pharmacy benefit managers, such as Express Scripts and CVS Caremark, regarding tens of thousands of prescriptions. The PBMs processed and approved claims for prescription drugs on behalf of insurance companies. Bolos and his co-conspirators defrauded the PBMs into authorizing millions of dollars’ worth of claims that private insurers such as Blue Cross Blue Shield of Tennessee, and public insurers such as Medicaid and TRICARE, paid to pharmacies controlled by the co-conspirators...READ MORE

The city of Las Vegas contracted with Northshore Clinical Labs to provide limited COVID-19 testing early this year, a city representative said this week...“This was when demand for testing was at its highest levels, and the city was trying to help meet that demand,” city representative Jace Radke said in an email. “The city has not entered into any other contracts with Northshore Clinical Labs, and is no longer affiliated with the company.”...Northshore was the target of a ProPublica investigation that revealed...the lab’s tests frequently gave inaccurate results. A test by the Nevada State Public Health Laboratory found a false-negative rate of 96 percent, meaning that Northshore’s test had missed nearly all positive cases in the sampling...READ MORE

CVS Health has asked Gov. Phil Scott to veto H.353 — a last-ditch effort to block a bill it says would raise prescription drug costs for Vermonters with private insurance...H.353 started out as a bill to make drugs more affordable by regulating pharmacy benefits managers, third-party companies that negotiate medication coverage plans for consumers with private insurers. But revisions of the bill, as it worked its way through the House and Senate, would have all but guaranteed that specialty drug prescriptions given to patients in health care settings, including expensive cancer medication, would be filled at the University of Vermont Health Network’s pharmacy in Burlington, rather than through cheaper mail-order pharmacies that insurers prefer...READ MORE

In its COVID-19 vaccine patent kerfuffle with Arbutus Biopharma and Roivant’s Genevant Sciences, mRNA hot shot Moderna aims to shield itself with its government contract...Plaintiffs Arbutus and Genevant sued Moderna back in February, seeking damages tied to six patents they claim Moderna infringed with the production and sale of its COVID-19 vaccine Spikevax...the plaintiffs should have sued the U.S. government instead, Moderna said in a filing at the U.S. District Court for Delaware. To back up its argument, Moderna cited a federal law once used to “’prevent patent infringement suits from interfering with the supply of war materials during World War 1.'”...Moderna explained that it supplied its COVID-19 vaccine to the feds as part of the nation’s emergency response to the pandemic. It's "difficult to conceive of a situation more within the heart" of the wartime law than the pandemic, the company argued...READ MORE

Two drug distributors cannot bring federal civil rights claims against UnitedHealthcare's pharmacy benefit manager Optum unit and an association of state pharmacy boards for allegedly shutting them out of the market by denying accreditation from state boards, a federal appeals court ruled...upheld a lower court judge's dismissal of a lawsuit by distributors PriMed Pharmaceuticals LLC and Oak Drugs Inc against Optum and the National Association of Boards of Pharmacy, finding the defendants could not be sued under the federal civil rights law because they were not state actors...According to the lawsuit, filed in federal court in Newark, PriMed and Oak Drugs, both of which operate in multiple states, were deprived of business because Optum, one of the nation's leading pharmacy benefit managers, requires pharmacies it works with to buy only from distributors accredited by NABP...The distributors said the NABP rejected their applications for accreditation without good reason, violating their due process rights...READ MORE

No one who provides a service does it for free. Professionals administer these services, and payment is expected...Have you heard about the uninsured person who walked into the pharmacy to get their second or third or fourth COVID-19 shot? The billing mechanism for these patients—the Health Resources and Services Administration—is now out of money, and yet we, the pharmacists, are expected to take care of these patients...According to the CDC website,“[The] COVID-19 vaccine is free of charge for everyone. Participating pharmacies will bill private and public insurance for the vaccine administration fee. For uninsured patients, this fee will be reimbursed through the Health Resources and Services Administration’s Provider Relief Fund.”...At least half the patients who come into the pharmacy will ask why we need their insurance card. “These shots are supposed to be free,” they say. I explain to them that it takes at least 15 minutes of our time to administer a shot, and even though the vaccine is “free”—and even the alcohol pads and syringes are “free”—there is still a cost...READ MORE

A lawyer for two Ohio counties said...that CVS Health Corp, Walgreens Boots Alliance Inc and Walmart Inc should fund an $878 million plan to address the opioid crisis there, as a first-of-its-kind trial got underway to determine the pharmacy chains' contribution...the counties want the companies to fund a $878 million five-year plan that Mark Lanier, a lawyer representing the counties, said on Monday was aimed at solving the opioid crisis rather than allocating blame...READ MORE

Former pharmaceutical executive Martin Shkreli was released from prison on Wednesday after serving most of his seven-year sentence for lying to hedge fund investors and defrauding drug company investors...Shkreli, 39, was released from a prison in Allenwood, Pa., and moved “community confinement,” or a halfway house overseen by the Federal Bureau of Prisons’ New York Residential Reentry Management Office, the AP reported. The bureau said his projected release date is Sept. 14...READ MORE

A Baltimore-based pharmacy and pharmacist have agreed to pay $15,000 in penalty and adhere to “corrective action” in a case that involves allegedly filling dozens of fraudulent prescriptions despite red flags...The United States entered into a consent decree with Ketan K. Dankhara and Falls RX LLC, doing business as Ultra Care Pharmacy Baltimore, which means the case was resolved without Dankhara and the pharmacy admitting guilt...READ MORE

Over the past few years, the Food and Drug Administration has come increasingly under scrutiny for its program to grant speedy approvals to drugs that show early signs of benefiting patients with life-threatening diseases...These so-called accelerated approvals have ushered in many new therapies, particularly for cancer. But they have also ginned up substantial controversy in several cases...because they brought to market high-priced therapies that weren’t proven to help people...Drugmakers have also faced criticism for dragging their feet on the follow-up studies meant to definitively show their medicines work...Soon, the FDA could receive new authority to compel pharmaceutical companies to follow through with these confirmatory studies and to order withdrawal of drugs that fall short of their initial promise...READ MORE