Supreme Court Addresses Pharmacy's Ability to Challenge Unfavorable UR Determination

The Pennsylvania Supreme Court on Wednesday ruled that a pharmacy provider cannot challenge a utilization review determination that the medications it dispensed were unreasonable and unnecessary in a fee review proceeding, and that such providers do not have a due process right to notice and an opportunity to intervene in UR proceedings, either. Thomas Shaw worked for the Roman Catholic Archdiocese of Philadelphia. He injured his knee in 2014 and received medical care from Dr. Bradley Ferrara. Keystone Rx LLC filled the prescriptions by Ferrara for Shaw’s injury and billed the ins...