The amount may be smaller than you think. Most PBMs have “arbitration” provisions with the American Arbitration Association (AAA). AAA has an efficient method of small dispute resolution. The “small dollar” claims include: reduced filing fees, limited discovery, and an expedited hearing schedule. For example, if your arbitration claim seeks damages in the amount of $10,000 or less, the AAA’s filing fee is only $775, and the arbitrator appointed to handle the matter serves at a reduced rate. Also, for arbitrations involving disputes under $10,000, the AAA’s procedures provide for a hearing “on the papers”. In other words, you do not have to travel to the hearing to testify.
The following PBMs currently have Arbitration provisions with AAA: CVS Caremark; Prime Therapeutics; Aetna; Humana; and Express Scripts.
What is “Fee Shifting” and which PBMs have “Fee Shifting” Provisions?
A “fee shifting” provision is a clause in a contract requiring the loser to pay the winner’s attorney’s fees. Both CVS Caremark and Express Scripts typically have both arbitration provisions and fee shifting provisions. The “fee shifting” provision is a good thing, especially if you believe that the audit is unfair, incorrect or abusive. Recovering your attorney’s fees and costs would make the arbitration a zero cost experience.
Medco is the Only Major PBM without an Arbitration Provision.
Frier Levitt is a law firm located in New Jersey that can efficiently handle such matters on a flat fee basis.
Will Frier Levitt Handle My Small Dollar Audit Claim on a Flat Fee Basis So that I Know My Downside Cost?
Yes. Frier Levitt handles small dollar arbitration claims (and of course larger audits) on a flat fee basis.
Frier Levitt is a boutique health care law firm representing thousands of community and specialty pharmacies across the United States in all aspects of pharmacy law. We have developed a reputation amongst PBMs as relentless legal advocates of independent pharmacies. Through a $12,000,000 class action recovery, and countless successful lawsuits and arbitrations, we challenge abusive PBM audit practices.
To learn more about how Frier Levitt can assist you in “small-dollar” arbitrations, contact us today.
