Increased State Scrutiny of Pharmacy Benefit Managers: Legislative Update, Litigation Challenges, Notable Settlements

Mr. Palmisano leads the legal team supporting customer contracting and various regulatory matters at Prime Therapeutics. His deep industry knowledge and breadth of experience across the legal spectrum allow him to assist the company as a counselor, negotiator, and advocate. Mr. Palmisano has worked within the PBM industry for almost 25 years. He joined Medco in early 2001 and worked there for more than 12 years, serving in a variety of leadership roles within the Legal and Compliance Departments. Those included leading the company’s efforts to contract customers whose annual revenues totaled $65 billion, litigating some of the company’s most significant disputes, and acting as the face of the company to CMS with respect to Medicare Part D matters. In 2014, he joined Magellan Rx, heading legal affairs for the pharmacy segment of Magellan Health. Prime Therapeutics acquired Magellan Rx in December 2022. Mr. Palmisano has worked extensively with the Pharmaceutical Care Management Association, the PBM trade association, on a variety of advocacy and litigation efforts, for the better part of the last 20 years.

For more than 25 years, Mr. Swichar has represented thousands of independent pharmacies and healthcare providers in regulatory, civil and criminal proceedings. His practice is dedicated to representing all provider types, throughout the U.S., including specialty pharmacies, mail order pharmacies, retail pharmacies, compounding pharmacies, home infusion pharmacies, tele-health pharmacies, hospital pharmacies, home care pharmacies, long term care pharmacies, oncology pharmacies, among others. Mr. Swichar has handled thousands of matters on behalf of such providers involving all aspects of their business operations including, but not limited to, issues with payors and PBMs, PBM audit appeals, challenges to network terminations, refusals to provide network access and in the submission of credentialing applications. Additionally, he routinely counsels pharmacies on reimbursement rate issues, reimbursement disputes and refusals by payors and PBMs to abide by federal and state any willing provider laws and other legal requirements. Mr. Swichar's pharmacy experience includes representing multiple retail, mail and specialty pharmacies in negotiating agreements with PBMs for dramatically-improved reimbursement rates for branded and generic drugs, resulting in millions of dollars in additional reimbursement. He has also assisted numerous pharmacies in obtaining network status after being denied and successfully represented pharmacies in overturning decisions by PBMs to terminate them from their networks. He has also represented numerous pharmacies in connection with responding to audits and has successfully challenged audit results. In addition, he has defended numerous pharmacies in connection with investigations by state boards of pharmacy, Attorney General Offices, United States Attorney's Offices and multiple other state and federal government agencies. Mr. Swichar also frequently consults with state and federal legislators in the drafting and proposing of legislation to reign in abuses by pharmacy benefit managers and improve protections afforded to pharmacies.

Mr. Wasser focuses his practice on litigation, regulatory compliance, and government advocacy, with a nationally recognized concentration in pharmacy law and disputes involving pharmacy benefit managers (PBMs). He provides strategic legal, regulatory, and business counsel to pharmacies, healthcare providers, and national healthcare associations, as well as clients in other regulated industries. As a member of Duane Morris’ Pharmacy Litigation Group, Mr. Wasser has developed deep experience representing pharmacies of all types—retail, mail-order, infusion, institutional, specialty—in high-stakes matters involving PBMs and insurance companies. His work spans disputes over network participation rights, provider terminations, audits, reimbursement rates, and contractual negotiations. He has successfully negotiated agreements that have secured significantly improved reimbursement terms for pharmacies, generating millions of dollars in additional revenue for his clients. He has also overturned PBM termination decisions, restored network access for denied providers, and effectively challenged adverse audit findings. Mr. Wasser frequently defends pharmacies in investigations by State Boards of Pharmacy, Attorneys General, United States Attorney’s Offices, and other regulatory authorities. He is also a trusted advisor to pharmacy owners and executives on compliance strategy, risk management, and government relations. In addition to his litigation and regulatory work, Mr. Wasser actively engages with state and federal lawmakers in drafting and advancing legislation designed to strengthen protections for pharmacies and healthcare providers.