In recent weeks and months, OptumRx, the in house pharmacy benefits manager (PBM) for UnitedHealthcare has engaged in a new course of action challenging Florida pharmacies that provide diabetic testing supplies through mail order. Contending that mail order is not permitted under the contract, OptumRx has begun sending cease and desist letters to Florida pharmacies and threatening network termination. OptumRx often sends these letters in connection with pending or uncompleted audits of a pharmacy.
In response to inquiries by pharmacies, OptumRx has stated that pharmacies wishing to do mail order may seek a “mail order addendum.” However, conditions imposed by OptumRx essentially pose an insurmountable barrier to entry for many pharmacies.
While we have seen this practice take place specifically in Florida, it may also be occurring elsewhere. It is important for pharmacies to understand that there may be certain defenses to such action being taken or threatened by a PBM, including Any Willing Provider Laws, and the fact that certain versions of OptumRx’s contract do not prohibit a pharmacy from providing mail order. It is important that pharmacies understand their rights and obligations before responding to these letters or taking action with respect to the PBM. Frier Levitt routinely handles these matters on behalf of pharmacies, and can advise pharmacies of their rights under their contracts and State law. Contact us today.
