Many medical benefit plan fiduciaries contract with pharmacy benefit managers (“PBMs”) to administer the prescription drug portion of their health plans, placing the PBM in charge of day-to-day management of the programs. Under the traditional PBM model, plan fiduciaries generally negotiate prescription drug prices with a PBM, which in turn negotiates pricing with drug manufacturers, profiting from the difference. This “spread pricing” has drawn the attention of policymakers in recent years. A proposed class […]

Prior to the COVID-19 public health emergency (“PHE”), the federal Ryan Haight Act allowed a provider to prescribe controlled substance medications to a patient only after conducting an in-person evaluation of that patient (with limited exceptions). At the beginning of the PHE, the Drug Enforcement Agency (“DEA”) granted temporary exceptions to the in-person requirement and allowed the prescribing of controlled medications via telehealth encounters in order to prevent lapses in care.

As reported here earlier, […]