In a growing trend, CVS Caremark (Caremark) has joined the ranks of PBMs to begin offering a mail order network in both commercial and Medicare Part D networks. Caremark has recently contacted a number of pharmacies participating in Caremark retail networks requiring they accept a Mail Order Pharmacy Addendum. This notice to pharmacies Caremark has identified to be operating under a “non-standard retail pharmacy model” based on the volume of claims submissions allegedly mailed to Caremark patients. Caremark is requiring the pharmacies either accept a Mail Order Pharmacy Addendum or voluntarily withdraw from all of Caremark’s commercial and/or Medicare Part D retail networks.
As could be expected, the offered Mail Order Pharmacy Addendum will levy additional terms and conditions that are allegedly more relevant to a “non-standard retail pharmacy model.” Pharmacies accepting this Mail Order Pharmacy Addendum can also expect to be subjected to new network reimbursement rates.
As indicated above, the only alternative offered to pharmacies receiving this notice is to withdraw altogether from Caremark’s networks. Pharmacies that have received this Addendum are highly encouraged to speak to an attorney. Addendums such as this one must be reviewed against the backdrop of federal and state laws. Should pharmacies accept this Addendum, any failure to adhere to the additional terms and conditions could result in audit recoupments and/or network termination. As has been seen with other PBMs, merely because a pharmacy is enrolled in a mail order network does not guarantee access to all plan sponsor’s networks (as benefit designs vary and may exclude “mail order benefits”).
If your pharmacy has been contacted by Caremark regarding this Mail Order Pharmacy Addendum, contact Frier Levitt to speak to an attorney today.