Frier Levitt Successfully Reduces 100% of PBM Audit Chargeback on Behalf of NY Pharmacy Client

A New York-based pharmacy client was facing an audit conducted by a major pharmacy benefit manager (“PBM”). During the audit, the PBM conducted an invoice reconciliation, causing it to assert thousands of unsubstantiated claims. In fact, the PBM initially alleged approximately 1,800 claims as discrepant due to drug invoice shortages (i.e., discrepancies between the amount of drug products purchased and the amount billed to the PBM). After working with the pharmacy to formulate a defense strategy and compile requisite documentation to dispute the findings, Frier Levitt presented the PBM with a comprehensive appeal response. The PBM ultimately reversed 100% of the discrepancies totaling $268K.

Defending against PBM audits is critical for pharmacies to remain in-network and avoid a potentially devastating financial outcome. This is especially true where the PBM has no basis to justify its recoupment efforts. In addition to avoiding substantial economic and reputational damage, taking prompt action ensures that your pharmacy can continue to provide patients with convenient, uninterrupted service.  

How Frier Levitt Can Help

Regardless of the size of your pharmacy or the amount at stake, Frier Levitt is ready to assist you in successfully challenging a PBM audit. Our attorneys are prepared to take an aggressive approach to defend your rights and to fight against abusive PBM audit practices on your behalf. For more information or for assistance with a PBM audit dispute, contact Frier Levitt to speak to an attorney.