After a PBM terminated our pharmacy client from its pharmacy Network, Frier Levitt successfully reversed the termination following an appeal and communication with the PBM. The PBM sent a Notice of Termination our client alleging that the pharmacy failed to comply with the terms and conditions of the PBM Provider Manual and Provider Agreement by submitting too many specialty claims in retail networks. However, the PBM never articulated how the alleged termination was proper under the Provider Manual and Provider Agreement.
Frier Levitt conducted an extensive appeal of the Notice of Termination and met and conferred with the PBM’s legal counsel. Thereafter, the PBM advised Frier Levitt that it was rescinding the Notice of Termination and that the pharmacy was allowed to continue its membership in the PBM’s networks.
Pharmacy providers should be cognizant that PBMs are continuing to terminate pharmacies from their networks based on arbitrary specialty dispensing thresholds with no basis in law or contract. Frier Levitt is well versed in the terms and conditions of PBM agreements, as well as federal and state law pertaining to PBMs and a provider’s statutory right to enjoy network access. Contact a Frier Levitt attorney if your pharmacy is facing termination by a PBM.
