Frier Levitt Successfully Reverses PBM Network Access Denial
Frier Levitt successfully negotiated network enrollment for an independent pharmacy into a national Pharmacy Benefit Manager (“PBM”) network. The Pharmacy’s enrollment application was initially denied by the PBM allegedly due to one of the Pharmacy owner’s relationship, ownership and/or affiliation with a pharmacy that was previously terminated by the PBM. Despite having made several attempts to clarify the underlying basis for the denial, the PBM ultimately denied the Pharmacy’s enrollment application. Subsequently, Frier Levitt intervened and successfully demonstrated that the Pharmacy owner delinked any ownership, relationship, and/or affiliation with the terminated pharmacy before the PBM removed the pharmacy from its network.
It is imperative that independent pharmacies 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 pharmacy and/or its owners. Moreover, the pharmacies are required to notify the PBMs of any changes made in the information noted in the credentialing application after the pharmacies are enrolled in the PBM’s network.
How Frier Levitt Can Help
If your pharmacy is being denied entry into a PBM network and requires assistance with securing access, Frier Levitt can help. Frier Levitt’s 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.