Among the tools used by Pharmacy Benefit Managers (PBMs) to clamp down on certain pharmacy operations (such as mailing of prescriptions), one of the most widely used is a “Cease and Desist” letter. PBMs routinely issue cease and desist letters to retail pharmacies when it appears that the pharmacy has engaged in a significant amount of mail order business. PBMs have historically restricted retail pharmacies from engaging in any routine mail order practice since PBMs seek to reserve the ability to conduct mail order for pharmacies in the PBMs’ mail order pharmacy network. Generally, PBMs will demand that a retail pharmacy sign an attestation agreeing to immediately cease and desist its mail order business or risk being immediately terminated from the network.
In some instances, agreeing to a PBM’s cease and desist request may be the best option, weighing the various risks and benefits. However, pharmacies agreeing to cease and desist letters or signing additional attestations must continue to ensure that they abide by the terms of those documents. Importantly, PBMs routinely continue to monitor pharmacy activity with the specific intent to determine whether the pharmacy has continued any such practice of mailing prescriptions in violation of its agreement with the PBM. In the event a PBM identifies even one prescription being mailed after the signing of the cease and desist or attestation, even by mistake, PBMs will likely take swift and immediate action to terminate the pharmacy.
Much can be done to prevent the inadvertent mailing of prescriptions after the signing of a mail order cease and desist with a PBM. First and foremost, the pharmacy must establish and implement a rigorous Corrective Action Plan (CAP) within the pharmacy to restrict pharmacy staff from the ability to mail prescriptions. The pharmacy must strictly adhere to the requirements as set forth by its CAP and periodically review the pharmacy staff’s compliance with the terms of the CAP. The strength of the pharmacy’s CAP and the ability for the pharmacy to successfully implement policies and procedures to prevent mailing prescriptions will provide the pharmacy with the tools necessary to prevent any inadvertent mailing and, ultimately, can protect a pharmacy from network termination.
If your pharmacy recently signed a mailing cease and desist with a PBM or is conducting a high volume of mail order on a retail contract, it would be advantageous to take proactive steps to prevent network termination. To discuss how your pharmacy can ensure compliance with its PBM contracts, contact Frier Levitt today.