Frier Levitt attorneys successfully reinstated an independent pharmacy into a major coupon processing network following the pharmacy’s abrupt suspension. The coupon processor notified the pharmacy of its suspension through an informal electronic communication, vaguely citing concerns allegedly identified during a review of recent claims submitted by the pharmacy. Even after the pharmacy swiftly complied with the coupon processor’s requests for additional information regarding those claims, it was not made aware of any outstanding concerns or discrepancies related to these claims before its abrupt suspension. Frier Levitt attorneys quickly intervened, emphasizing the pharmacy’s inability to substantively appeal or otherwise address the allegations, and requested further engagement between the parties.
Following the pharmacy’s suspension, Frier Levitt reached out directly to the coupon processor to request clarification regarding the specific concerns underlying the suspension, including allegations that cash coupon cards had been inappropriately applied to ineligible claims, and to propose a discussion to address the allegations. In response, the coupon processor indicated that in addition to the concern that the pharmacy inappropriately applied coupons, the pharmacy had been uncooperative during the audit and had reversed claims after the audit was initiated.
Frier Levitt worked with the pharmacy to obtain documentation to demonstrate the coupons were appropriately applied, and that any claim reversals were at the patients’ direction and not in response to the audit. Frier Levitt attorneys worked with the pharmacy to obtain signed patient attestations confirming that patients had requested the reversals and specifying the dates of those requests, which directly negated the processor’s concerns about the timing of these reversals. Following its review of those attestations, the processor agreed to reinstate the pharmacy, conditioned on the pharmacy’s express commitment to verify patient coverage, confirm coupon eligibility criteria, and comply with the applicable terms of copayment assistance programs before submitting claims.
This outcome underscores the importance of proactively engaging experienced pharmacy counsel and rigorously confirming the eligibility of every claim before submission by reviewing both the coupon processor’s participation terms and the individual coupon’s conditions. Point‑of‑sale approvals and processor submissions can occur even when a claim is ineligible under program terms. Therefore, pharmacies should confirm coupon applicability at the claim level before applying any coupons or other patient assistance to claims.
How Frier Levitt Can Help
If your pharmacy has received similar communications from coupon processors, or has concerns about its compliance with coupon and patient assistance program terms, Frier Levitt can help. Contact us to speak to an attorney.
