As we approach the end of the calendar year, Pharmacy Benefit Managers (PBMs) engage in a crucial process – the review of pharmacies within their networks. This review encompasses a comprehensive assessment of various facets of pharmacy operations, including an examination of past audit performance and any past adverse actions taken against a pharmacy. Additionally, it may entail the initiation of “re-credentialing” procedures. Major PBMs will (and some of them have already begun to) conduct the year-end review of their network pharmacies.
When a pharmacy is called upon to undergo re-credentialing, it enters a phase where it must respond to a series of inquiries that cover a wide range of topics. These inquiries touch on the fundamental aspects of the pharmacy’s existence, such as ownership structure, location and hours of operation, business transactions, potential common ownership with other pharmacies, and any prior disciplinary actions from State Boards of Pharmacy or other PBMs. During this critical phase, pharmacies bear the responsibility of not only providing information that is accurate to the best of their knowledge but also of diligently identifying any inconsistencies between the details in the re-credentialing form and those in their initial credentialing submission. Transparency is of utmost importance during this process. Many PBMs mandate that pharmacies promptly disclose any modifications or updates to the information initially furnished to the PBM during the initial credentialing process.
Should PBMs detect any disparities or come across any false or erroneous statements during their review, it could lead to unwelcome consequences for the pharmacy. These consequences could range from delays in the re-credentialing process to, in more severe cases, a complete denial of re-credentialing. Hence, it is imperative for pharmacies to approach this re-credentialing process with precision and integrity, ensuring that all information provided aligns accurately with their operational realities and initial submissions. This commitment to accuracy and transparency is not only a compliance requirement but also a safeguard for continued participation within the PBM network.
How Frier Levitt Can Help
If your pharmacy has received a PBM re-credentialing request, contact Frier Levitt to speak to an attorney today on how the pharmacy can best address the request. Similarly, if your pharmacy is seeking admission into a particular PBM network, speak to one of our experienced attorneys to help your pharmacy through this process.
