Frier Levitt Partner Dae Lee Quoted in Drug Topics: Rise of Third-Party Pharmacy Audits
Frier Levitt partner Dae Lee was recently quoted in Drug Topics article “Rise of Third-Party Pharmacy Audits” by Keith Loria.
Pharmacy benefit managers (PBMs) regularly perform audits on pharmacies, either directly or through third-party representatives. The process for appealing these audits is generally consistent. Nevertheless, pharmacies are obligated to provide comprehensive responses to the audits and the ensuing findings. This is crucial because PBM audits could lead to recouping previously paid claim reimbursements and even potential network termination or suspension.
Dae notes that pharmacies must respond to audit requests and audit findings with supporting documents. He states, “It is important to note that PBM provider manuals detail the types of supporting documents that would be acceptable by the PBMs.”
Additionally, “Responding to PBM audit is an onerous process that forces the pharmacy to invest its time and financial resources. However, if a pharmacy fails to resolve discrepancies identified in the audit findings, PBMs will recoup the entirety of reimbursement paid on the prescription claims. PBMs can also use the audit findings against the pharmacies and initiate network suspension/termination.”
For more insights on PBM audits, read the full article in Drug Topics here.