Frier Levitt successfully reversed network enrollment denial by a national Pharmacy Benefit Manager (“PBM”) against a Dispensing Physician Practice (“Practice”). The PBM denied the Practice’s enrollment application because the Practice allegedly did not meet the terms and conditions of the PBM Provider Manual. Subsequently, Frier Levitt intervened and helped the Practice navigate complex credentialing process and requirements. However, when it became clear litigation was necessary, Frier Levitt filed for an arbitration. Shortly after the filing, the PBM’s litigation counsel contacted Frier Levitt to resolve the matter, and the PBM allowed the Practice into its network.
It is imperative that independent pharmacies and dispensing physician practices prepare and submit a complete credentialing application when attempting to gain admission into a PBM’s pharmacy network. The credentialing application is an onerous process whereby PBMs often request pharmacy applicants to disclose business and ownership information, pharmacy licenses, dispensing practices, and disciplinary actions taken against the applicants and/or its owners.
How Frier Levitt Can Help
If your pharmacy or dispensing physician practice is being denied entry into a PBM network and requires assistance with securing access, Frier Levitt can help. Our attorneys have substantial experience and knowledge in the specific concerns that PBMs have with respect to network access and have assisted numerous pharmacies in overcoming PBM contracting issues. Contact us today to speak with an attorney.
