Frier Levitt has recently been successful in reversing wrongful terminations of pharmacies from Pharmacy Benefit Manager (PBM) networks. The PBMs agreed to reinstate the contractual terms with no interruption in service dates.
PBMs perform routine audits on pharmacies which many times result in a number of discrepancy findings. If the pharmacy is unable to successfully contest these discrepancy findings, the PBM may present a notice of termination. In response to this notice of termination, PBMs provide for a window of time to appeal the grounds for its termination decision. This critical time for appeal can determine the future for a pharmacy, especially since terminations generally result in a 1-year, or even a 5-year, waiting period before the pharmacy can re-apply to the PBM network. Termination from a PBM network can cause substantial economic and reputational damage to a pharmacy. Therefore, it is vital to understand your rights as a pharmacy to appeal a termination decision.
Frier Levitt has substantial experience in negotiating termination reversals on behalf of pharmacies. To better understand the tools available to you as a pharmacy in fighting termination from PBM networks, contact Frier Levitt today.
