Frier Levitt recently assisted an independent pharmacy with a PBM audit in which the PBM claimed the pharmacy had inventory shortfalls for over twenty drugs. Frier Levitt reviewed the pharmacy’s invoice documentation, and submitted an appeal on behalf of the pharmacy. While awaiting results of the appeal, the pharmacy received a notice of termination from the PBM based on the inventory shortfalls identified in the audit. Frier Levitt worked with the PBM to review the pharmacy’s appeal response, resulting in a recalculation of the audit findings to only $20,000 from the original $186,000 amount. The significantly-reduced audit findings, along with a demonstration of corrective measures, led the PBM to rescind the notice of termination, allowing for the pharmacy’s continued participation in the PBM network.
PBM audits can make or break an independent pharmacy not only by subjecting the pharmacy to large recoupment amounts, but also by compromising the pharmacy’s network status. Contact Frier Levitt to speak with a PBM attorney for help with your audit.