Regardless of the Recoupment Amount, PBM Audit Appeals are Essential to Prevent Network Termination Based on Negative Audit History

Often, many pharmacies allow PBM audit findings to go uncontested due to smaller claw back amounts. Even if a PBM audit does not result in adverse action beyond the recoupment of monies from the pharmacy, PBMs keep track of their network pharmacies’ audit histories. Increasingly, PBMs are using prior audit results as justification to terminate the pharmacy years later after the pharmacy has another adverse audit finding. Though the smaller amounts may not seem “worth” disputing, failure to do so may serve as the basis for network termination by a PBM somewhere down the road.

No audit is too small or insignificant to go unchallenged. Frier Levitt works with pharmacies regarding PBM audit findings and other PBM-related issues, including contract documents and other abusive PBM practices to which pharmacies are frequently subjected. Contact Frier Levitt today to speak to an attorney.