Frier Levitt recently learned of an unfair audit practice by Medco Health Solutions, Inc. (“Medco”). Has Medco approved claims submitted for insulin prescriptions at the point of sale, only to recoup/retract the money after an audit?
We are looking for pharmacies willing to challenge Medco on this issue. Unchecked PBM behavior will further erode independent pharmacy profits. Frier Levitt fights PBMs on behalf of pharmacies.
Insulin Issue: Potential Class Action against Medco.
According to manufacturer specifications, Lantus and Humalog each have a 28-day “shelf life” after the package is opened. Once opened, the vial’s remaining contents are good for another 27 days. After the 28th day, the remaining contents in the vial are no longer suitable for use Problems often arise when Medco audits a pharmacy and recovers substantial monies where the pharmacy has dutifully taken into account the shelf-life in dispensing the insulin medications and submitting the claim to Medco.
The following example is helpful to better understand: 1000-unit vials are the smallest package size for these particular insulin medications. Doctors frequently prescribe either Lantus or Humalog for diabetics at 30 units per day and prescribe a 60-day supply. A pharmacy would thus dispense three (3) 1000-unit vials of the insulin medication (because each vial is only good for 28 days; thus it would take 3 vials to fill a 60-day supply per the prescription). After filling and dispensing the prescription to the patient, Medco audits the pharmacy and seeks to recover the full amount of the second and/or third vial because the pharmacy should have entered the claim as a 100-day supply (i.e., 3000 units/30 units per day = 66.67), but instead input the claim as a 60-day supply per the prescribing physician’s instructions.
We believe this issue lends itself to resolution through a class action!
Contact Frier Levitt if you have experienced this unfair audit practice. We handle these matters on a contingency fee basis. We are only paid if we are successful in recovering money for you.
