7th Circuit Rules “Usual and Customary Pricing” Can Include Discount Programs

Posted on May 31, 2016 in Case Analysis, Materiality, Pharmacy

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A recent whistleblower case could have a significant impact on Medicare Part D charge limits and corresponding reimbursement and could have ripple effects for aspects of other Medicare programs. The Seventh Circuit Court of Appeals ruled that reduced prescription prices offered by a large retail pharmacy (here Kmart) to participants enrolled... Continue Reading →

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