NEWS AND PUBLICATIONS

  2022 is here, and brings welcome news for independent pharmacies: New York State Governor Kathy Hochul has signed landmark legislation providing for oversight of pharmacy benefit managers, described as being "the most comprehensive regulatory framework in the country for Pharmacy Benefit Managers. "The new law should significantly benefit in...

Collection of copayments has traditionally been one of the more difficult aspects of pharmacy practice. Indeed, collection of copayments has become more difficult in recent years, as health insurers have steadily increased copayment amounts as part of the low-premium, high patient cost-sharing model. This has resulted in an increase of patients who...

The demise of Rochester Drug Cooperative ("RDC") continues, and this time it is retail pharmacies that must beware of the fallout. In March 2020—following numerous private, state and federal government-led lawsuits accusing RDC of being complicit in the opioid crisis—RDC filed for bankruptcy and sought to wind down its operations. As part of this, ...

​ Q.   As a New York State employer, what paid sick leave or family leave laws are currently applicable to my business? ​A.  New York State employers are currently/will shortly be subject to: The Families First Coronavirus Response Act (federal law passed in response to COVID-19 crisis) New York State Paid Family Leave law (passed in...

Governor Andrew M. Cuomo and NYS Department of Health Commissioner Howard A. Zucker have ordered all medical facilities located in New York State— i.e. hospitals, ambulatory surgery centers, office-based surgery practices, and diagnostic & treatment centers—to take certain measures aimed at increasing bed capacity for COVID-19 patients. An offi...

The New York State opioid litigation, led by private plaintiffs and the Office of the Attorney General of the State of New York, has taken another turn.Plaintiffs' counsel has now issued subpoenas to thousands of New York State-based pharmacies who are not parties to the litigation.These subpoenas demand a wide range of documents and information pe...

IMPORTANT CLIENT ALERT The latest edition of OptumRx (ORX) Provider Manual (2019 4 th Edition) contains significant new provisions pertaining to maintenance of records by pharmacies.We expect that, in connection with desktop audits, ORX may start demanding documentation additional to that routinely reviewed in the past and may potentially decline t...

Sauchik & Giyaur, P.C. (the "Firm") recently secured reversal of network terminations for five providers, ensuring that the providers continued as participating providers. The individual providers, who were part of the same practice, had received abrupt network termination notices from a prominent insurance plan. The Firm, on behalf of the prov...

The NYS Office of the Medicaid Inspector General ("OMIG") has dramatically increased enforcement activity in connection with Medicaid provider compliance programs: OMIG is notifying providers that their compliance programs are being placed under review. Providers should take immediate action to avoid the prospect of serious sanctions, including but...

The number of Medicare appeals cases pending to be heard by administrative law judges has been growing exponentially.  The backlog is now almost ten times larger than it was five years ago and is projected to reach two million by 2020 if no change is made.  The appeals process, as of now, takes at least three to four years, duri...

This is the time for independent pharmacies to be actively preparing for the impact of the Cigna-ESI merger—and the ensuing Aetna-Caremark merger—if they have not already done so. The Antitrust Division of the U.S. Department of Justice has approved the proposed Cigna-Express Scripts merger, clearing a significant obstacle to Cigna's acquisition of...

2006 was a monumental year for New York physical therapists – New York State passed a law permitting physical therapists to directly treat patients without a referral from a physician, triggering an explosion of private physical therapy practices. Over a decade later, private practice is still thriving in the industry.  As patient volume ...