New York Pharmacy Benefits Bureau: Seventh Request for Comment Seeks Input on PBM Pharmacy Audits

Since being established in May 2022, New York’s Pharmacy Benefits Bureau (“Bureau”) has requested input from the public on six separate occasions regarding New York’s laws governing Pharmacy Benefit Managers (“PBMs”). The Bureau’s seventh and most recent request seeks additional Public Comments regarding PBMs in New York. The Bureau, as an Administrative Agency, is authorized to enact rules and regulations that could potentially benefit independent pharmacy providers, plan sponsors, and other stakeholders throughout New York (and beyond). So far, the Bureau has requested comments on several critical issues including:

  • PBMs’ duties to health plans under New York’s Public Health Law;
  • Reporting requirements for PBMS under New York Insurance Law;
  • PBM patient-steering practices;
  • PBM conduct while credentialing and recredentialing pharmacies into a PBM network;
  • The need for additional rules the public believes should be implemented;
  • PBM reimbursement practices.

The Bureau’s seventh and most request for public comment provides another unique opportunity to offer guidance directly to the Bureau on important issues involving PBMs. In its seventh request for Public Comments, the Bureau seeks input and information from the public about audits of pharmacies by PBMs including on the following topics:

  • How PBMs communicate audit policies and procedures to pharmacies
  • Types of audits experienced in the past five (5) years including onsite audits, prescription validations, invoice reconciliations, desktop audits, investigations, etc.
  • How many times per year for the past five (5) calendar years have PBM audits occurred for your pharmacy?
  • In what way, if any, have you been able to contact the auditing PBM with questions regarding audit findings, auditor conduct, or otherwise? Please specify the auditing PBM and the method by which they provided for communication.
  • Approximately how many claims were audited during the most recent audit of your pharmacy performed by a PBM?
  • Has your pharmacy experienced issues with audit results seeking the recoupment of claims relating to patient or prescriber denials?
  • The impact audit findings have had on your pharmacy’s network participation.
  • The impact audits have had on pharmacy staffing, particularly with respect to staff time used to respond to audit requests.

The Bureau encourages any interested parties to submit any comments by March 24, 2023. If you would like to work with Frier Levitt to participate in this process, please contact us as soon as possible as there is limited time to prepare and submit a comment to the Bureau. Frier Levitt has experience preparing and submitting comments to various government agencies including the Bureau.   

This is another opportunity to be a leader on important issues and offer unique insight and perspective on PBMs with the Bureau and participate in New York’s rulemaking process.

How Frier Levitt Can Help

Frier Levitt represents thousands of pharmacies across the United States as well as various other life sciences and healthcare industry stakeholders with an emphasis on PBM issues (including in New York) and has successfully taken on some of the most troubling PBM tactics including improper PBM audit and recoupment practices, PBM network access issues, DIR fees, and PBM reimbursement issues. Our attorneys have extensive knowledge of all aspects of PBMs in terms of their relationships with payors and pharmacies. Contact us to speak with an attorney about how payors and pharmacies can leverage the various laws and protections afforded to such entities, including the important PBM laws in New York.