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Drug and DME Pricing

This archive displays posts tagged as relevant to drug and durable medical equipment pricing. You may also be interested in our pages:

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The Missing Ventilator Stockpile Was Not Inevitable

Posted  04/3/20
By Sarah “Poppy” Alexander
Hospital Building Sign
The coronavirus crisis has been a crash course for the general public in how lifesaving ventilators work.  But the federal government has long known how crucial they are and how important it is to be able to stockpile sufficient numbers.  Five years ago, the government tried to plan ahead by commissioning the design and production of a low-cost ventilator to build up public and private stores in case an...

Medicaid Drug Rebate Fraud: Should it be an Enforcement Priority?

Posted  03/10/20
pill container spilled over with pills in the form of a dollar sign
Medicaid has one very intuitive approach to keeping drug prices in check. Drug companies, under a law called the Medicaid Drug Rebate Program, must rebate Medicaid programs any money that resulted from the increased drug prices outpacing inflation. Inflation is benchmarked to either 1990, or the first year a drug came to market, which ever is later. As an example of how this works, imagine a pharmaceutical company...

Top Ten State Healthcare and Financial Fraud Recoveries of 2019

Posted  01/30/20
mount-rushmore-and-state-flags
Here at Constantine Cannon, our attorneys represent whistleblowers reporting a wide variety of healthcare fraud and financial fraud, including government contract fraud, unlawful kickbacks, tax evasion, and more. While such wrongful conduct often violates federal laws, state governments are also important enforcement authorities. For whistleblowers, state enforcement can offer additional opportunities.  New York,...

January 21, 2020

Patient Services, Inc., a foundation that operated pharmaceutical patient assistance programs, will pay $3 million to resolve claims that it unlawfully enabled pharmaceutical companies to pay kickbacks to Medicare patients in the form of co-payment assistance for patients who took the companies’ drugs.  PSI was alleged to have worked with the drugmakers to funnel their “contributions” to patients who took the company’s drugs, instead of using the contributions for purposes not tied to specific drugs and patients.  PSI was alleged to have worked with Insys on copayment assistance for Subsys patients; with Aegerion on copayment assistance for Juxtapid patients; and, with Alexion on copayment assistance for Soliris patients.  USAO Mass

November 20, 2019

The Assistance Fund, a foundation that provided funds for pharmaceutical patient assistance programs, will pay $4 million to resolve claims that it conspired with three manufacturers of multiple sclerosis drugs, Teva, Biogen, and Novartis, to improperly funnel contributions from those companies to patients purchasing drugs from those companies.  USAO MA

November 15, 2019

Pharmaceutical manufacturer Lupin Limited and related entities, together with company executives Vinita Gupta and Robert Hoffman, will pay $63 million to Texas to resolve claims under the Texas Medicaid Fraud Prevention Action that they reported inflated drug prices to the state's Medicaid program in order to receive excess reimbursements.  The investigation of Lupin was initiated by a whistleblower lawsuit filed by Expess Med Pharmaceuticals, Inc.  TX

November 7, 2019

Compound drug ingredient supplier Fagron Holding USA LLC has agreed to pay over $22 million to resolve two qui tam suits involving three of Fagron’s wholly-owned subsidiaries.  According to whistleblowers, Freedom Pharmaceuticals Inc. grossly inflated the price of active pharmaceutical ingredients used in compound prescriptions, causing pharmacy customers to submit false claims to TRICARE.  Other allegations involved subsidiaries Pharmacy Services Inc. and B&B Pharmaceuticals Inc., which were accused of submitting false claims to federal healthcare programs, manipulating prescription drug pricing, paying kickbacks to physicians, and illegally waiving patient copays.  DOJ

October 28, 2019

The State of Illinois has reached a settlement with more than a dozen drug manufacturers alleged to have published inflated "average wholesale prices" for drugs whose purchase was reimbursed by Illinois's Medicaid program at prices based on those false AWPs.  The settlement for $242 million includes Abbott Laboratories, Inc.; Aventis Pharmaceuticals Inc.; Aventis Behring LLC, n/k/a ZLB Behring; B. Braun Medical Inc.; Forest Laboratories, Inc.; GlaxoSmithKline LLC; Johnson & Johnson, Inc.; Janssen Pharmaceutical Products, LP; McNeil-PPC, Inc.; Ortho Biotech Products, LP; Ortho-McNeil Pharmaceutical, Inc.; Novartis Pharmaceuticals Corporation; Pfizer Inc.; Pharmacia Corporation; and TAP Pharmaceutical Products, Inc.  In total, Illinois has settled inflated AWP claims against more than four dozen manufacturers (see, e.g., January 2019 settlement with TEVA Pharmaceuticals), recovering $678 million in total.  IL AG  

May 31, 2019

Generic drug maker Heritage Pharmaceuticals, Inc. has entered into a deferred prosecution agreement for criminal antitrust charges, admitting that it conspired to fix prices, rig bids, and allocate customers for the diabetes drug glyburide.  Heritage will pay a $225,000 criminal penalty and has agreed to cooperate in ongoing antitrust investigations.  In addition, Heritage will pay $7.1 million to resolve allegations under the False Claims Act that the company paid and received unlawful remuneration under the Anti-Kickback Statute through its arrangements with other generic drug makers regarding prices, supply, and allocation of customers for drugs including glyburide, hydralazine, and theophylline.  DOJ; USAO ED Pa

April 30, 2019

Pharma company US WorldMeds LLC has agreed to pay $17.5 million and enter into a corporate integrity agreement to resolve allegations that it improperly induced the use of its drugs Apokyn, used to treat Parkinson's, and Myobloc.  The company was alleged to have improperly used a foundation to pay Apokyn copayments for Medicare beneficiaries, knowing that it was the only donor to the foundation’s Parkinson’s Disease fund and that virtually all of the fund’s donations were spent on Medicare Apokyn patients.  In addition, the company was alleged to have paid kickbacks to physicians, including excessive speaking and consulting fees, to induce them to prescribe Apokyn and Myobloc. The litigation was initiated under the False Claims Act by whistleblowers, who will receive $3.15 million of the settlement.  DOJ; USAO Conn
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