Frier Levitt recently represented a New York pharmacy that had suffered a termination without adequate notice directly from a major plan sponsor. The plan stated the termination was in light of recent guidance from CMS and the Office of Inspector General of the Department of Health and Human Services (OIG) related to alleged questionable billing practices related to certain lidocaine creams and topical treatments, and it sought to identify and remove outliers from its network. It terminated the pharmacy on three days’ notice.
In response, Frier Levitt immediately contacted the plan and initiated a dispute, eventually drafting a complaint it was prepared to file in federal court alleging breach of contract, among other claims. In the face of these actions, the plan ultimately reinstated the pharmacy.
Frier Levitt routinely represents pharmacies against predatory practices of Pharmacy Benefits Managers (PBMs) and plan sponsors that seek to illegally exclude pharmacies from their networks. If your pharmacy is involved in a termination, audit, or other dispute with a plan sponsor or PBM, contact Frier Levitt today to speak with an attorney your options to fight back.
