Frier Levitt was recently successful in reversing a Florida pharmacy’s network termination by a major PBM. The PBM had sent a Notice of Termination alleging that the pharmacy failed to comply with terms and conditions set forth by PBM Agreement and Provider Manual by waiving copays and processing unwanted refills. Notably concerning was that the pharmacy did not receive any notice of audit prior to receiving the Notice of Termination.
Frier Levitt’s Life Sciences Associate Dae Y. Lee, Pharm.D., Esq. conducted an extensive appeal of the termination and advanced the matter towards meet-and-confer with the PBM’s legal counsel. Shortly before the scheduled meet-and-confer, the PBM informed Frier Levitt that, solely based on the appeal of the termination, it will reverse the Notice of Termination and that the Pharmacy is allowed to continue its membership in the PBM’s network.
Pharmacies are facing heightened scrutiny by largely unregulated PBMs in the form of unreasonable audits, recoupment, and termination. Frier Levitt is well versed in the terms of the various PBM Manuals and Provider Agreements as well as state audit laws which set forth the parameters for pharmacy payment and audits. Frier Levitt leverages that knowledge to effectively protect the rights of pharmacies who are unfairly targeted by PBMs.
Contact Frier Levitt if your pharmacy is subject to an adverse action by a PBM including audit, recoupment and/or termination.