PHARMACY ALERT: New Medicare Part D Claim Recoupment By PBMs
While the majority of independent pharmacies have continued to see their margins shrink because of below market pricing and self-serving tactics implemented by Pharmacy Benefit Managers (“PBMs”) that only benefit themselves, Frier Levitt recently identified a new type of reimbursement issue that has impacted independent pharmacies across the country. Specifically, a national Pharmacy Benefit Manager (“PBM”) informed its network pharmacies – only when the pharmacies made inquiries to the PBM after discovering recoupment on their remittance reports – that it had inadvertently applied commercial pricing to certain Medicare Part D claims and ended up paying higher reimbursements on the said claims to the pharmacies. Again, the PBM withheld reimbursements due and owing to the pharmacies without providing any prior notice to offset the alleged overpayment on the Medicare Part D claims. These claims at issue were for the prescriptions that have been filled and dispensed by the pharmacies in the last two years. This recoupment tactic not only impacts the pharmacy’s day-to-day operation but also patient care especially when various federal and state agencies as well as private payors have taken a series of actions to ensure that patients have access to healthcare and to support the need for business continuity for healthcare providers during the COVID-19 pandemic.
How Frier Levitt Can Help
Frier Levitt represents pharmacies across the United States in challenging PBM audits, network access and reimbursement practices and policies. If your pharmacy is facing unreasonable PBM recoupment, you may only have a short time to dispute them. Contact Frier Levitt today to speak to an attorney.