To print this article, all you need is to be registered or login on Mondaq.com. The Louisiana Insurance Department ("Department")recently fined Express Scripts Administrators, LLC("ESA") $275,000 and MedImpact Healthcare Systems, Inc.("MedImpact") $250,000 for allegedly failing to payelectronically adjudicated insurance claims to pharmacies in atimely manner on behalf of the Louisiana Office of Group Benefits("OGB"). OGB provides health and life insurance benefitsto Louisiana-qualified state employees, retirees of participatingLouisiana state agencies, and eligible dependents. ESA andMedImpact are third party administrators ("TPAs")operating as pharmacy benefit managers ("PBMs") forOGB. Per a recent press release issued by the Department, its Officeof Consumer Services investigated ESA and MedImpact after receivingthousands of remittance advices from the Louisiana IndependentPharmacy Association to substantiate complaints from 19 independentpharmacies alleging numerous violations of the Louisiana InsuranceCode. As a result of the Department's investigations, itdetermined that both PBMs failed to ensure electronicallyadjudicated claims were paid within 15 days as required byLouisiana law. The Department's press release also indicated that ESAadmitted to failing to pay 1.3 million electronically adjudicatedclaims within 15 days due to a software issue. ESA has paid $1.5million in interest to the affected pharmacies and also agreed topay a $275,000 fine and to make the necessary changes to itsprocesses and procedures specified in a Consent Order with theDepartment. The Department's press release indicated that 664,770 claimswere paid by MedImpact in excess of 15 days as required byLouisiana law. MedImpact agreed to pay $602,000 in interest to theaffected pharmacies and to pay a $250,000 fine. Commissioner Donelan also announced in the Department'spress release that neither the software issue cited by ESA, nor thestate of emergency declaration cited by MedImpact (related to theCovid-19 pandemic) excused ESA or MedImpact from complying withLouisiana law. The content of this article is intended to provide a generalguide to the subject matter. Specialist advice should be soughtabout your specific circumstances. AUTHOR(S)

United States: Louisiana Insurance Department Fines Express Scripts And Medimpact For Delayed Pharmacy Payments - Polsinelli LLP

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A Rite Aid store in the East Village neighborhood of New York 23. , Photographer: Angus Mordant/Bloomberg
(Bloomberg) -- Bankrupt pharmacy chain Rite Aid Corp. has until March 1 to complete its turnaround under a timeline approved by a federal judge on Tuesday. US Bankruptcy Judge Michael Kaplan scheduled a final hearing that day to decide the fate of the company’s reorganization proposal. The ruling comes after complaints that the case was moving so fast it threatened to harm lower-ranking creditors, including people who claim Rite Aid wrongly sold addictive pain killers. The company, backed by senior lenders, had urged Kaplan to hold the hearing in February, arguing that the longer Rite Aid stays in bankruptcy, the more likely it is to liquidate instead of finding a buyer willing to rescue the retailer. Rite Aid faced pressure from its two official creditor committees to slow the pace of the reorganization. A panel of lower-ranking, unsecured creditors and a group representing opioid victims argued that they need more time to review the $3.45 billion loan package Rite Aid says it needs to help fund its reorganization. The company has filed a proposal built on the assumption Rite Aid will have a successful pair of auctions set for December. The heart of the proposal can’t be finished until after the sale is locked down. During a court hearing held by video Tuesday, Rite Aid lawyers said they are hoping to attract multiple offers for the entire company. Currently, it has agreed to sell its valuable pharmacy benefits manager to MedImpact Healthcare Systems for $575 million, unless a higher bid comes in. Last week, Rite Aid said MedImpact was having “financing issues.” To help keep the deal alive, Rite Aid has agreed to help finance the purchase. The move is unusual for a corporate bankruptcy auction; bidders typically must prove they can afford to buy whatever is up for sale before being allowed to participate. The case is Rite Aid Corp., 23-18993, US Bankruptcy Court for the District of New Jersey. ©2023 Bloomberg L.P.

Rite Aid Bankruptcy Judge Sets March 1 Deadline to Reorganize

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The Louisiana Insurance Department (“Department”) recently fined Express Scripts Administrators, LLC (“ESA”) $275,000 and MedImpact Healthcare Systems, Inc. (“MedImpact”) $250,000 for allegedly failing to pay electronically adjudicated insurance claims to pharmacies in a timely manner on behalf of the Louisiana Office of Group Benefits (“OGB”). OGB provides health and life insurance benefits to Louisiana-qualified state employees, retirees of participating Louisiana state agencies, and eligible dependents. ESA and MedImpact are third party administrators (“TPAs”) operating as pharmacy benefit managers (“PBMs”) for OGB. Per a recent press release issued by the Department, its Office of Consumer Services investigated ESA and MedImpact after receiving thousands of remittance advices from the Louisiana Independent Pharmacy Association to substantiate complaints from 19 independent pharmacies alleging numerous violations of the Louisiana Insurance Code. As a result of the Department’s investigations, it determined that both PBMs failed to ensure electronically adjudicated claims were paid within 15 days as required by Louisiana law. The Department’s press release also indicated that ESA admitted to failing to pay 1.3 million electronically adjudicated claims within 15 days due to a software issue. ESA has paid $1.5 million in interest to the affected pharmacies and also agreed to pay a $275,000 fine and to make the necessary changes to its processes and procedures specified in a Consent Order with the Department. The Department’s press release indicated that 664,770 claims were paid by MedImpact in excess of 15 days as required by Louisiana law. MedImpact agreed to pay $602,000 in interest to the affected pharmacies and to pay a $250,000 fine. Commissioner Donelan also announced in the Department’s press release that neither the software issue cited by ESA, nor the state of emergency declaration cited by MedImpact (related to the Covid-19 pandemic) excused ESA or MedImpact from complying with Louisiana law.

Louisiana Insurance Department Fines Express Scripts and Medimpact for Delayed Pharmacy Payments

Rite Aid has secured interim approval to access up to $3.45 billion in debtor-in-possession financing. Senior Editor
Rite Aid has received approvals from the U.S. Bankruptcy Court for the District of New Jersey for its “First Day” motions related to the company’s voluntary Chapter 11 petitions filed on Oct. 15, 2023. The Court granted interim approval to access up to $3.45 billion in debtor-in-possession financing from certain of its lenders. This financing is expected to provide sufficient liquidity to support the company throughout this process. Among other things, the Court has authorized the company to continue to pay associate wages, salaries and benefits without interruption, pay vendors and suppliers in full for goods and services provided on or after the filing date of Oct. 15, 2023, and otherwise continue to deliver leading healthcare products and services across its retail and online platforms. “We are pleased to have received Court approval of these critical First Day motions, which will enable Rite Aid to continue serving our customers and meeting their pharmacy needs throughout this process,” said Jeffrey Stein, CEO and chief restructuring officer of Rite Aid. “With the support of certain of our lenders and the majority of our bondholders, we look forward to moving through this process and emerging as a stronger company, well-positioned for long-term success. We thank our associates, partners, suppliers and vendors for their continued support and our associates for their hard work and dedication.”
As previously announced, Rite Aid reached an agreement in principle with certain of its senior secured noteholders on the terms of a financial restructuring plan that will allow the company to accelerate its ongoing business transformation. Implementing the contemplated restructuring plan will significantly reduce the company’s debt, increase its financial flexibility and enable it to execute on key initiatives. Additionally, as previously announced, Rite Aid has also entered into an agreement with MedImpact Healthcare Systems, an independent pharmacy benefit solutions company, pursuant to which MedImpact will acquire Rite Aid’s Elixir Solutions business. Under the terms of the agreement, MedImpact will serve as the “stalking horse bidder” in a court-supervised sale process under section 363 of the U.S. Bankruptcy Code. Accordingly, the proposed transaction is subject to higher and better offers, court approval and other customary conditions. Elixir Solutions is operating normally and continuing to serve clients, plan sponsors, members and customers as usual. Elixir Insurance is not included in Rite Aid’s Chapter 11 process or the proposed transaction with MedImpact, and it is continuing to operate and serve members as usual.

Rite Aid receives court approval of motions supporting business operations

The pharmacy retailer plans to use bankruptcy to shrink its store footprint and manage a nearly $4 billion debt load. Published Oct. 16, 2023
First published on
Dive Brief:
Rite Aid on Sunday filed for Chapter 11 bankruptcy protection in New Jersey. The company said in an announcement that some of its lenders have offered $3.45 billion in new funding to provide the company liquidity in bankruptcy. Bankruptcy will also enable Rite Aid to shrink an unprofitable store footprint , manage a debt load that’s reached nearly $4 billion and regain more favorable trade terms with vendors, the company said in court documents. Also Sunday, Rite Aid announced the appointment of Jeffrey Stein as CEO and chief restructuring officer, effective immediately. Stein will also serve as a member of the board of directors and replaces interim CEO Elizabeth “Busy” Burr, who had led the company since January. Burr will remain on the board. Dive Insight:
In court documents, Stein said “a confluence of operational and financial factors have stressed Rite Aid’s financial condition and necessitate a comprehensive reorganization.” Stein outlined six issues that contributed to the company’s untenable financial position. They include substantial debt, which limits the company’s ability to execute turnaround initiatives and make in-store investments; financial and operational headwinds; a “sub-optimal retail footprint” and $80 million each year in “dead rent” costs from leases it can’t exit; and competitive pressures. "The announcement of Rite Aid's bankruptcy is a sobering reminder of today's evolving dynamics within the retail industry,” James Gellert, CEO and executive chairman of financial analytics firm RapidRatings, told Retail Dive in an email. “With [a financial health rating] of just 21 out of 100, Rite Aid faced an uphill battle further complicated by litigation troubles and set against the backdrop of a high-interest rate environment with rapidly shifting consumer demands.”
Rite Aid said in court documents it has between $1 billion and $10 billion in liabilities and assets and more than 100,000 creditors. The company’s top three creditors — pharmaceutical company McKesson, U.S. Bank Trust National Association and health insurer Humana — are collectively owed more than $1 billion. “It became evident that a restructuring through Chapter 11 would best position Rite Aid for long-term success,” Stein said. “An orderly process — with support from key creditors — should help the company maintain trade credit and obtain post-petition financing to preserve thousands of jobs, continue operations in Chapter 11, and take the necessary steps to right-size the business for a successful emergence.”
The company also said it has entered into an agreement with MedImpact Healthcare Systems to acquire Rite Aid’s Elixir Solutions pharmacy benefit manager. Under the terms of the agreement, MedImpact will serve as the stalking horse bidder in a court-supervised sale process. In the interim, Elixir Solutions is maintaining regular operations. Elixir Insurance is not part of Rite Aid’s Chapter 11 or the proposed deal with MedImpact, and it is also maintaining regular operations. Established in 1962, the Philadelphia-based company said in court documents that it has 2,111 stores in 17 states, seven distribution centers, 9,000 vendors and 45,000 employees. It fills about 200 million prescriptions annually. News emerged in late August that the company would likely file for bankruptcy . Those Chapter 11 rumblings caused trade terms to contract, with vendors increasingly demanding security deposits, cash on delivery or cash in advance. Stein said Rite Aid lost more than $100 million in liquidity in September and early October due to tighter trade terms. Rite Aid also faces more than 1,600 opioid-related lawsuits. The company is accused of contributing to America’s opioid epidemic by knowingly oversupplying prescription painkillers. “Rite Aid could use a Chapter 11 bankruptcy plan to pause most lawsuits and channel opioid liability claims to a trust,” Alessandra Glorioso, a bankruptcy partner at law firm Dorsey & Whitney, said in emailed comments. “However, bankruptcy may not give Rite Aid a breathing spell from the Department of Justice actions, because some bankruptcy courts find that False Claims Act suits are an exercise of the government's police power, which is exempt from the automatic stay.”
The company also faces litigation related to contract disputes, other government investigations and securities matters. The ongoing lawsuits are affecting the company’s liquidity and complicate the ability to explore out-of-court resolutions, Stein said. “In a different market environment,” Gellert said, “Rite Aid may have been able to extend its fuse life through an 11th-hour capital grab as other companies, such as GameStop and AMC, have been able to do in the past few years. However, given the mountain of risks facing RiteAid, retail investors are now unwilling to play ball and institutional investors are more circumspect and expensive than any time in the last decade.”
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MedImpact Healthcare Systems is a full-service Pharmacy Benefit Manager (PBM) that derives revenue by managing the drug benefit, not from dispensing drugs. The company uses information technology and human capital to improve the practice of managed care pharmacy. MedImpact partners with the nation's finest health plans, hospitals and employers to provide pharmacy benefit management services to more than 35 million members.

Name	Work History	Title	Status
Dale Brown	Cardinal Health, Express Scripts, CVS Health, and Humana	President, Senior Vice President	Former
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