We’ve all heard the examples where failure to notify one state’s Board of Pharmacy of disciplinary action imposed by another state’s Board of Pharmacy has had a cascading effect, resulting in spiraling and circuitous fines and discipline. However, did you know that failure to provide timely notification of discipline (and other actions) can have PBM implications as well?
Many PBM manuals contain sections detailing the obligation to report disciplinary actions, investigations and/or proceedings against the pharmacy, often requiring written notification for actions including:
- Pharmacy’s licenses or permits being in jeopardy of being, suspended or revoked
- Legal proceedings are initiated against the pharmacy that could lead to an adverse action against the pharmacy, or any of their respective officers, directors, current/former employees, or owners
- Any adverse action taken by a Board of Pharmacy, the Office of Inspector General (OIG), Food and Drug Administration (FDA), Drug Enforcement Agency (DEA), or other government regulatory or enforcement entities
- A subpoena of records is issued to the pharmacy relating to the PBM’s members
- A seizure by law enforcement of the pharmacy’s prescription records, computer systems, financial records, accounts or real property
- Pharmacy is terminated from another third-party payer’s network
One area that can be problematic for pharmacies is the timing of when disclosure is required to be made. PBM manuals typically require disclosure of any reportable action within 5-10 business days (or sooner, depending on the seriousness of the circumstances). However, when that obligation arises may differ from PBM to PBM, and in the case of disciplinary action by a Board of Pharmacy, could range from as late as the date a Consent Order is signed and made effective, to as early as the date notice is provided of an upcoming inspection by the Board of Pharmacy.
Finally, separate and apart from direct PBM reporting, many credentialing agencies also require disclosure of similar conduct. Certain credentialing organizations have revoked pharmacies’ accreditations over failure to timely report discipline, which in turn, has had a corresponding impact on pharmacies’ ability to remain contracted in certain PBM networks.
Frier Levitt routinely assists pharmacies in ensuring compliance with not only Board of Pharmacy reporting obligations, but also contractual reporting obligations. If you’ve received notice of a Board of Pharmacy inspection, disciplinary proceeding or proposed Consent Order, contact Frier Levitt today to speak to an attorney.