- The Current State of Electronic Prior Authorization in the US (ajmc.com)National adoption Scorecard Electronic Prior Authorization (ePA) (epascorecard.covermymeds.com)
A majority of pharmacies have publicly announced that they are committed to implementing an electronic prior authorization solution that sends prior authorization requests electronically to the prescriber…70% of EHR systems…are committed to ePA. Eighty-seven percent of payers…are committed to ePA…CVS/pharmacy is the last major chain not yet committed to an ePA…many independent pharmacies have access to ePA functionality through pharmacy systems, most of which have live, integrated ePA capabilities…Prior authorization legislation has been considered, and in some states is in effect…Currently, 23 states have passed legislation pertaining to PA, and 4 additional states have pending legislation. The legislation seeks to make the PA submission process faster and easier for providers to prevent the delay of patient treatment…there is no federal direction on PA, so each state is on its own with respect to creating and enacting PA legislation...
- Pharmacist at center of Valeant scandal accuses drugmaker of ‘massive fraud’ (latimes.com)
..pharmacist Russell Reitz…agreed to sell his pharmacy (R&O Pharmacy), in a quiet suburban office park, to the group (East Coast investors) for $350,000…he continued as manager, Reitz began finding his store's name and his national pharmacy license number on an avalanche of prescriptions nationwide…a torrent of insurers' money started flowing to his small shop…on pace to equal $230 million a year…Reitz now finds himself at the center of the national scandal enveloping Valeant…In the last two months, Reitz has filed papers in two Los Angeles courthouses laying out details of what he and his lawyer call "a massive fraud."…Until Reitz's court filings…few people knew about Valeant's close ties to Philidor...Reitz detailed how he had discovered that Philidor was using his national pharmacy identification number on prescriptions being filled at other pharmacies — and even on some that were filled and billed before he signed the agreement to sell R&O…Reitz said he believes that Philidor had targeted his pharmacy because it needed access to his licenses, which he has in California and 33 other states, as well as to the contracts he had negotiated with insurers.
- AmerisourceBergen posts 13.7% revenue increase for fiscal 2015 (drugstorenews.com)
AmerisourceBergen…reported $136 billion in revenue for its fiscal year 2015 ended Sept. 30, representing an increase of 13.7%. Adjusted diluted earnings per share from continuing operations were $4.96, an increase of 24.9% over the prior fiscal year…we made a strategic acquisition of MWI Veterinary Supply and earlier this month announced a definitive agreement to acquire PharMEDium Healthcare Holdings…these acquisitions strengthen our position in the pharmaceutical supply channel, and enhance our ability to grow in the future..
- A Tech Revolution Is Quietly Taking Place In Healthcare (realclearmarkets.com)
While policymakers, and the country, struggle over challenges facing and created by the Affordable Care Act, real healthcare reform is happening almost completely outside of that loop, driven by technology and innovators, many of whom are from outside the healthcare industry…Health IT or Digital Health-the generic terms used to describe these disruptions that include the use of mobile devices and telemedicine, among other changes-are breaking almost every standard healthcare paradigm. It's that "creative destruction" that economists frequently refer to, transforming how care is delivered, received, tracked, paid for and even understood…And unlike traditional healthcare, where the more money you have the more healthcare your get, the health IT revolution largely ignores those barriers. That's because the poor have mobile devices in almost similar numbers to the rich.
- Warner Chilcott Agrees to Plead Guilty to Felony Health Care Fraud Scheme and Pay $125 Million to Resolve Criminal Liability and False Claims Act Allegations (justice.gov)
Warner Chilcott U.S. Sales LLC, a subsidiary of pharmaceutical manufacturer Warner Chilcott PLC, has agreed to plead guilty to a felony charge of health care fraud, the Justice Department announced...The plea agreement is part of a global settlement with the United States in which Warner Chilcott has agreed to pay $125 million to resolve its criminal and civil liability arising from the company’s illegal marketing of the drugs Actonel, Asacol, Atelvia, Doryx, Enablex, Estrace and Loestrin…company committed a felony violation by paying kickbacks to physicians throughout the United States to induce them to prescribe its drugs, manipulating prior authorizations to induce insurance companies to pay for prescriptions of Atelvia that the insurers may not have otherwise paid for and making unsubstantiated marketing claims for the drug Actonel…As part of today’s resolution, the whistleblowers will receive approximately $22.9 million from the federal share of the civil recovery.
- California doctor convicted of murder charges in overdose of patients (latimes.com)
A Rowland Heights doctor was convicted of second-degree murder…in connection with the overdose deaths of three patients, capping a landmark case that was closely watched by medical and legal professionals across the country…Dr. Hsiu-Ying “Lisa” Tseng, who prosecutors say is the first doctor convicted of murder in the United States for recklessly prescribing drugs to patients, was accused of ignoring “red flags” about her prescribing habits, including the overdose of a patient in her clinic and nine phone calls in less than three years from authorities informing her that patients had died with drugs in their system…. Tseng was one of only a handful of doctors across the country who have faced murder charges for prescribing painkillers that led to a patient's death...
- WBA to divest as many as 1,000 stores to secure Rite Aid deal approval (drugstorenews.com)
The merger agreement between Walgreens Boots Alliance and Rite Aid must be consummated by Oct. 27, 2016, or the deal is off, according to documents filed to the Securities and Exchange Commission on Thursday…If Rite Aid walks away from the deal at any time, Rite Aid will forfeit a $325 million termination fee to Walgreens. Rite Aid may also be required to pay up to an additional $45 million to cover expenses incurred by Walgreens…Conversely, Walgreens will forfeit $325 million to Rite Aid if it's not able to secure regulatory approval of the deal, a figure that could double to $650 million if Walgreens "enters into, consummates or announces certain acquisitions within eight to 12 months of the date of the merger agreement…Walgreens is willing to divest as many as 1,000 locations, or other holdings not to exceed an aggregate value of $100 million, in an effort to secure approval of the acquisition..
- OPA announces opposition to marijuana oligopoly ballot initiative (ohiopharmacists.org)Ohio voters weigh legalizing recreational marijuana use (reuters.com)
Ohio Pharmacists Association, the state organization representing Ohio’s pharmacist practitioners, announced their opposition to the Ohio Marijuana Legalization Initiative, Issue 3, which if passed which would place legalized marijuana and a protected oligopoly of select commercial marijuana growers into the Ohio Constitution…OPA is unconvinced that marijuana is appropriate or beneficial as a form of treatment for illness or disease. Further, OPA rejects any medical marijuana proposal that removes the function, counsel, and expertise of the prescriber and pharmacist from the prescription process, as Issue 3 does…“If there is going to be a legitimate discussion about marijuana policy or the possible effectiveness of marijuana for medical purposes, then let’s have it. But ‘Responsible Ohio’ bypasses the discussion altogether in an effort to benefit to a few wealthy investors. Issue 3 is a slap in the face to Ohioans who genuinely care about sensible marijuana policy.”
- McKesson significantly exceeds Wall Street expectations with Q2 results (drugstorenews.com)
McKesson…exceeded Wall Street analyst expectations by 32 cents, reporting adjusted earnings of $3.31, up 19% as compared to year ago figures. Revenues for the second quarter ended Sept. 30 were $48.8 billion, up 10%. On a constant currency basis, revenues increased 14% over the prior year…McKesson…repurchased approximately 2.5 million shares totaling nearly $500 million, announced the acquisition of the U.K. pharmacy operations of Sainsbury’s and the acquisition of the pharmaceutical distribution business of United Drug Group in Ireland…
- New York Pharmacist and Two Others Face Criminal and Civil Charges for Multimillion-Dollar Oxycodone Distribution Scheme (dea.gov)
Drug Enforcement Administration…announced...an indictment today against three individuals and two pharmacies for a multimillion-dollar oxycodone distribution scheme…through pharmacies operated in Brooklyn and Queens. Lilian Jakacki, Marcin Jakacki, Robert Cybulski, European Apothecary Inc, Chopin Chemists, MW&W Global Enterprises Inc…charged with illegally distributing more than 500,000 pills of oxycodone...with a street value between $10 million and $15 million. The defendants are also charged with money laundering and health care fraud…one of the largest illegal diversions of oxycodone…in a New York State pharmacy. Pharmacies also illegally diverted more than 160,000 additional pills by accepting 1,300 fraudulent prescriptions…including prescriptions made out in the names of famous luxury brands such as “Coach” or “Chanel.”










