Arbitrator Rules that LTC Pharmacy has No BAE Obligation;  Awards $554,281 for Unpaid Co-pay Claims.
 
An arbitrator has ruled that Prime Therapeutics, a Pharmacy Benefit Manager under contract to several Part D plans must pay Omnicare $554,281 for improperly adjudicated co-payments. The arbitration found that Omnicare had properly submitted the co-payment claims to Prime and had not collected the co-payments from low-income beneficiaries.  The arbitrator rejected Prime Therapeutics defense that Omnicare had not submitted “Best Available Evidence” and therefore was not entitled to payment. The arbitrator ruled, that under the terms of the contract between the parties, Omnicare had no obligations to collect BAE in order to be paid. Prime Therapeutics has asked a Federal Court to vacate the arbitrator’s ruling. A decision on Prime Therapeutics Motion to Vacate is expected in about one month.

For a copy of the decision please click here.