ARTICLE
18 August 2014

OIG Posts Advisory Opinion On Pharmacy Referrals

Today, the Office of Inspector General of the Department of Health and Human Services posted an advisory opinion regarding a specialty pharmacy’s request to pay local retail pharmacies a fee for support services in connection with patient referrals.
United States Food, Drugs, Healthcare, Life Sciences

Today, the Office of Inspector General of the Department of Health and Human Services posted an advisory opinion regarding a specialty pharmacy's request to pay local retail pharmacies a fee for support services in connection with patient referrals.  In short, the opinion concluded that the proposed arrangement could potentially generate prohibited remuneration under the anti-kickback statute.

More details follow.  Specifically, the requestor pharmacy dispenses specialty drugs directly to patients but, in some instances, local pharmacies would be presented with a prescription.  The requestor pharmacy would enter into contracts with the local pharmacies to help the patients obtain the specialty drugs as well as associated counseling about those drugs.  Because some of the counseling services would be undertaken by the local pharmacy, the requesting pharmacy was seeking to provide compensation at the fair market value (so-called "per-fill fees").

OIG found that the proposed arrangement would involve payment for referred services and, as such, would be inherently subject to abuse because there was a link between fees and patient referrals.

The content of this article is intended to provide a general guide to the subject matter. Specialist advice should be sought about your specific circumstances.

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