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Pharmacy ALERT: Increased Scrutiny on PBM Credentialing Applications

Recently, Pharmacy Benefit Managers (PBMs) have been subjecting pharmacies and their credentialing applications to additional scrutiny. In one instance, a major PBM sought to terminate a pharmacy for its failure to report disciplinary action against the Pharmacist-In-Charge’s license that occurred over 17 years prior. In another instance, another PBM attempted to terminate a pharmacy for allegedly not updating its ownership information. Frier Levitt was able to assist both pharmacies in successfully reversing those terminations.

As a matter of course, in order for a pharmacy to gain admission into a PBM’s pharmacy networks, a pharmacy must complete a credentialing application. Such credentialing applications often make extensive inquiries as to the pharmacy’s business and ownership information, pharmacy licenses, dispensing practices, etc. PBMs will even request information on past disciplinary action and prior termination from any other PBM networks. In addition, to the extent that any of the information provided to the PBM at the time of credentialing changes through the course of participation in the PBM’s networks, pharmacies are usually required to timely inform the PBM of any such changes.  

Pharmacies are advised to carefully navigate through the completion of credentialing applications, regularly review its submission, and make any necessary updates. Frier Levitt can assist pharmacies in this process and work to ensure compliance with any reporting requirements.

Contact Frier Levitt to speak to an attorney today.