Frier Levitt recently assisted a New York-based independent pharmacy that was placed under temporary payment suspension by a national Pharmacy Benefit Manager (“PBM”). Notably concerning, the temporary suspension was effectuated while the Pharmacy was undergoing the dispute resolution procedure warranted by the PBM. More troubling, the PBM had withheld significant amount of reimbursement in excess of the alleged discrepant amount found in the PBM’s initial audit findings. Upon learning of the facts and the procedural history of that matter, Frier Levitt leveraged its established communication channel with the PBM, which agreed to lift the payment suspension and release the funds being held in excess of the alleged discrepant amount.
Contesting PBM audits and challenging adverse actions such as payment suspension or adjudication suspension taken by a PBM against a pharmacy is critical to ensure that pharmacies are not having money improperly recouped from the pharmacy without a sufficient basis to justify the recoupment and to ensure they are not being exposed to additional liabilities or other adverse actions/consequences. Effectively navigating these complex proceedings can be difficult and challenging — working with experienced legal counsel can be critical to achieving favorable results.
How Frier Levitt Can Help
Frier Levitt has extensive experience working with independent pharmacies throughout the United States on all aspects of PBM audits from their inception through litigation in those circumstances where litigation becomes necessary. The attorneys at Frier Levitt include clinicians and experienced litigators who are prepared to take all necessary steps to fight on behalf of a pharmacy in connection with PBM audits. If you have questions or need help with a PBM dispute, including PBM audits, contact us today to speak to an attorney.
