Category Archives: Pharma Part D

Magistrate’s Recommendation Rejected in Humana Case

29 Sep 2014 Roy Franco No Comments

Blog, Medicare Conditional Payments, Medicare Jurisdiction, Medicare Secondary Payer News, Pharma Part D, Reimbursements, Trial Practice

This past March we wrote about the Magistrate’s recommendation to the Judge handling the Humana Insurance Co. v. Farmers Texas County Mutual Insurance Co. Cause No. 13-CV-611-LY to dismiss the claim. Our analysis of that recommendation can be found here. In brief, we compared the decision process to a boxing match that would inevitably end up in the appellate courts. …

Blog, Pharma Part D

The Centers for Medicare & Medicaid Services (CMS) issued an important alert on August 19, 2014.  An issue of contention with the Agency by the Industry has been the pricing of prescription drugs.  Typically allocations returned with a counter higher letter by the review contractor are due to a conflict for the proposed cost of pharmaceuticals.  These discrepancies has led …

Humana’s Suit Against Farmers in Texas — UPDATE

23 Jan 2014 Roy Franco No Comments

Blog, Medicare Advantage Part C, Pharma Part D

We previously blogged about lawsuits brought by Humana against Farmers Insurance in four jurisdictions across the country.  We have been informed that Humana voluntarily dismissed three of the complaints (Tennessee, Missouri and Kansas), however the case brought in Texas is moving forward. Recently, Farmers moved to dismiss Human’s Texas litigation.  That motion is being rigorously opposed by Humana in the …

FDA Denies Approval of Generic OxyContin

19 Apr 2013 Roy Franco No Comments

Blog, Pharma Part D

On April 16, 2013, the Food & Drug Administration announced that it will not be approving generic OxyContin, the same day the patent expired for the abuse resistant type.  The FDA action appears in line with national concern over the meteoric rise in opiates use since 2000.  Today, this drug turns into a gummy substance if an addict attempts to …

Blog, Medicare Conditional Payments, Pharma Part D

Several months ago we blogged about  In re: Avandia Marketing, Sales Practices and Products Liability Litigation Glaxosmithkline, LLC & Glaxosmithkline, PLC Humana Medical Plan, Inc. and Humana Insurance Company, individually and on behalf of all others similarly situated, 2012 U.S. App. LEXIS 1320. We felt strongly about the expansion of the Medicare Secondary Payer Act’s private cause of action for …

Medicare Advantage Part C, Medicare Secondary Payer News, Pharma Part D, Uncategorized

We previously wrote on the In Re Avandia decision granting new Medicare Secondary Payer powers to Medicare Advantage and Part D Plans.  As predicted, such Plans are bullish over their new authority.  Letters are being sent by Part C and Part D Medical carriers addressed to insurance carriers and self insureds who are settling or otherwise responsible to make payment …

Blog, Medicare Advantage Part C, Medicare Conditional Payments, Medicare Jurisdiction, Pharma Part D

Potts vs. Rawlings Company LLC- 2012- U.S. Dist. Court for Southern Dist. NY Facts: This interesting case involves a putative class action against Medicare Advantage (MA) Plans, including Part D Drug Plans.   Plaintiffs sought protection from defendants’ reimbursement claims for conditional payments under New York State General Obligation Law §5-335.  Because this State Law prohibits Defendants, as benefit providers, from …

Lyrica: No Brand-Name Swansong

27 Jul 2012 Roy Franco No Comments

Medicare Conditional Payments, Pharma Part D, WCMSA

Lyrica is one of the most expensive chronically prescribed drugs used in workers compensation spine/back cases. Lyrica is a anticonvulsant drug used to treat chronic neuropathic back or spine pain, such as pain in a leg that persists after a lumbar spine injury. Prior to Lyrica, Gabapentin had been the primary anticonvulsant drug used for neuropathic pain, and its cost …

Medicare Advantage Part C, Medicare Conditional Payments, Pharma Part D

Overview Humana, a Medicare Advantage Plan, used the Medicare Secondary Payer Private Cause of Action (42 U.S.C. Section 1395y(b)(3)(A) to bring suit against a self insured primary plan.  The lawsuit was brought in Federal Court to recover damages for the failure of the primary plan to reimburse or otherwise provide for primary payment of medical items and services related to …

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