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So You’ve Signed a Mail Order Cease and Desist: What Every Retail Pharmacy Should Know

Among the tools used by Pharmacy Benefit Managers (PBMs) to clamp down on certain pharmacy operations (such as mailing of prescriptions), one of the most widely used is a "Cease and Desist" letter. PBMs routinely issue cease and desist letters to retail pharmacies when it appears that the pharmacy has engaged in a significant amount of mail order business. PBMs have historically restricted retail pharmacies from engaging in any routine...

Frier Levitt Helps Save Pharmacy Over $390K in PBM Audit

Frier Levitt recently assisted an independent pharmacy with an audit after a PBM alleged that several drugs showed a shortfall of inventory. Frier Levitt worked with the pharmacy and reviewed all records of the drug purchases, and provided proof of purchases by way of cancelled checks. The PBM considered the documents and Frier Levitt was able to help reduce the amount owed by the pharmacy from $394,000 to only $3,800....

Frier Levitt Saves Texas-Based Pharmacy Over $10k in PBM Audit

Frier Levitt helped a Texas-Based pharmacy facing a PBM audit that alleged the pharmacy had inventory shortfalls due to an issue of drug pedigree. Frier Levitt assisted the pharmacy in conducting an invoice reconciliation to identify that there actually was no shortfall. The PBM was required to reconsider the invoice submitted while clarifying the documentation submitted to demonstrate pedigree was acceptable and appropriate under state and federal law and the...

Major PBM Demands 10% Mail Order Attestation

Recently, a major PBM has demanded that its network retail pharmacies submit an attestation agreeing to limit mail order and delivery services to 10% of its claims submitted to the PBM. The PBM is now requiring independent pharmacies to agree to this limitation or risk being terminated from network. Attestations, or other forms of provider certifications, from PBMs must be taken seriously, and a failure to abide by the terms...

Frier Levitt Successful in Rescinding Pharmacy’s PBM Termination

Early this year, an independent pharmacy received a notice from their PBM demanding that the pharmacy immediately cease and desist mailing to their members. The notice alleged that the pharmacy had been engaged in mailing on a retail contract, which was prohibited by the PBM. Despite the fact that the pharmacy agreed to cease and desist mailing, months later the PBM sought to move forward with terminating the pharmacy for...