Has Medco audited and retracted money for a “Refill Too Soon” where the prescription was filled early to satisfy a patient’s request for a vacation supply?
Frier Levitt recently learned of an unfair audit practice by Medco Health Solutions, Inc. (“Medco”). Have you experienced Medco’s wrongful conduct relating to “vacation supply” refills that are approved at the point of sale, only to be recouped later in an audit? We are looking for pharmacies that are tired of being harassed by PBMs and that are willing to challenge Medco. Unchecked PBM behavior will further erode independent pharmacy profits. Frier Levitt will fight PBMs on behalf of pharmacies.
Medco has been auditing pharmacies and recovering money because the pharmacy has “Refilled Too Soon”. Pharmacists often refill early because a patient has advised that he will be on vacation on the refill date. In the majority of cases we have seen, the correct supply is dispensed and the correct amount paid by Medco within the sixty (60) day period because only a sixty (60) day supply is dispensed in the sixty (60) day period. Medco’s refill too soon amounts to a penalty and possibly to a “windfall” to Medco.
Medco’s TelePAID© system initially rejects the refill as “too soon”. However, the pharmacy is permitted to enter a “Vacation Supply” override code into TelePAID© to dispense the refill. Medco’s auditor later recovers the amount paid for the refill. Medco alleges that the pharmacy failed to note on the face of the written Rx that it refilled early for a “vacation supply”.
There is another variation of the same audit theme. Medco will audit and retract money alleging “Exceeds Plan Limits”. When pressed, Medco will not provide the Plan Sponsor Documents to test the veracity of Medco’s audit finding. This is unfair.
We believe these two issues lend themselves to resolution through a class action because of the common themes.
Contact Frier Levitt today if you have had either experience, or have experienced similar PBM audit abuse that you think is widespread.
We handle these matters on a contingency fee basis. We are only paid if we are successful in recovering money for you.
