Pharmacy ALERT: PBM Re-credentialing Requests and Performance Reviews

As the calendar year comes to an end, Pharmacy Benefit Managers (PBMs) often review pharmacies that participate in their networks. Such reviews may include an evaluation of past audit performances or any past adverse action taken against the pharmacy, or such reviews might include requesting the pharmacy to undergo “re-credentialing.” Pharmacies that are asked to undergo re-credentialing are often asked a series of questions associated with general ownership structure, location and hours information, business transactions, potential common ownership of other pharmacies, potential disciplinary action from State Boards of Pharmacy or other PBMs, etc.

In providing responses, it is critical that pharmacies ensure they are not only providing accurate information, but also identifying any discrepancies between this re-credentialing form and their initial credentialing form. Many PBMs require pharmacies to make the appropriate disclosures during the course of their participation in the networks of any changes to the information initially submitted to the PBM at the time of credentialing. To the extent that PBMs identify any differences in the information being submitted, or identify any false or inaccurate statements, pharmacies could expect a delay, or even a denial, in the re-credentialing process.

If your pharmacy has received a request to re-credential, contact Frier Levitt today to speak to an attorney and learn about our Flat Fee offerings for pharmacies looking to credential or re-credential into pharmacy networks.