Earlier this year, we alerted pharmacies to notices of billing discrepancies that AstraZeneca was sending to pharmacies who, from AstraZeneca’s calculations, did not purchase sufficient quantities of FARXIGA to support the claims being billed. Now, AstraZeneca has issued a new wave of “Data Discrepancy Reconciliation” letters regarding branded FARXIGA, expanding its review beyond 2024 into 2025, and has requested that pharmacies provide data to confirm the billing discrepancies that AstraZeneca appears to have identified on their end through 2025. If your pharmacy received a letter similar to the one described above, consider seeking legal guidance immediately.
What’s New in the Latest Letters
- Expanded Timeframe: AstraZeneca states that discrepancies continue into 2025—not just 2024—and is requesting totals for purchases and dispensed for both years.
- Broad Data Demands: Pharmacies are asked to reconcile branded FARXIGA purchases vs. dispensed, provide payer and month-level reports. Importantly, pharmacies are being asked to work with their PBMs to reprocess any claims related to billing discrepancies.
- Continuing Reprocessing Requests: Some pharmacies were told their practices have improved but are nonetheless being asked to reprocess and rebill all “impacted” claims, which may be an impossible task for many pharmacies.
Why Legal Guidance Is Critical When Responding: Potential Downstream Risk
The importance of legal guidance cannot be overstated when responding to manufacturer notices like these, as acting without counsel can create significant downstream risks. These letters implicate several critical areas, including PBM relationships and audits, since reprocessing claims and sharing data with manufacturers may impact network status, trigger PBM audits, or lead to recoupments and clawbacks, and even network terminations. They also raise concerns about government scrutiny, as patterns of noncompliance could attract regulatory review.
If Your Pharmacy Received This Letter: How Frier Levitt Can Help
Our team has assisted numerous pharmacies in responding to manufacturer demands like these, including AstraZeneca’s recent notices. Contact Frier Levitt today to understand the obligations and risks in providing a response to AstraZeneca, and to develop a strategy to address these requests, and mitigate any potential exposure your pharmacy may have. Frier Levitt is actively assisting pharmacies with these AstraZeneca letters. If you received one, contact us today to speak with an attorney.
Frier Levitt provides strategic, industry-focused legal counsel tailored to your needs. Contact our team today to learn how we can help you.
