As PBMs review pharmacies’ participation in their retail pharmacy networks, pharmacy providers may find themselves at risk for termination. Recently, Frier Levitt assisted a New York-based retail pharmacy from termination where the PBM alleged inventory shortfalls for multiple drug products following a Fraud, Waste, and Abuse (FWA) investigation.
Prior to requesting Frier Levitt’s assistance in the matter, the pharmacy had independently tried to appeal their investigation results. However, due to a shorter turnaround time given that it was an investigation, and not having sufficient clarity or information to resolve the alleged discrepancies, the pharmacy was unable to resolve the PBM’s findings. As a result, the PBM had taken swift action to terminate the pharmacy from the PBM’s networks. After working with the pharmacy to address the alleged findings, Frier Levitt continued the conversation with the PBM on the pharmacy’s behalf and clarified that the pharmacy had sufficient inventory for the drug products at issue. Briefly, the drug shortages resulted from the PBM failing to account for a wholesaler’s closure where the wholesaler did not adequately log and transfer invoice data to the PBM. Following the submission of additional purchase information and documentation, the PBM reduced the original findings by 99%. Ultimately, given the minor discrepancies that remained outstanding and the overwhelming demonstration that the pharmacy was in compliance with the PBM’s terms and conditions, the PBM permitted the pharmacy to remain in-network and reversed any action it had intended to take against the pharmacy.
Pharmacies that undergo any investigation or audit with a PBM are cautioned to take proactive efforts to resolve discrepancies as unresolved findings may lead to termination. Specifically, we urge all pharmacies to maintain an accurate and updated accounting of the pharmacy’s total inventory. Independent pharmacies must review their inventory and ensure compliance with all State, Federal, and PBM requirements.
How Frier Levitt Can Help
If your pharmacy is undergoing an audit or investigation and requires assistance, contact Frier Levitt today to speak to an attorney. Frier Levitt’s attorneys have substantial experience and knowledge in the specific concerns that PBMs have regarding network access and have assisted numerous pharmacies in overcoming PBM termination issues.
