Frier Levitt Successfully Reverses Full PBM Audit Chargeback for New Jersey Specialty Pharmacy Client

Frier Levitt was recently successful in assisting a New Jersey-based specialty pharmacy with the reversal of a full audit chargeback of over $100,000 plus the additional audit fee. A major PBM had conducted an extensive audit on the pharmacy and ultimately only identified alleged concerns regarding adequate proof of delivery, though there were no corresponding patient denials that would have otherwise suggested patients did not receive their respective medications. In this case, it was clear that the pharmacy had ensured successful receipt of the medication by its patients and maintained appropriate documentation per the terms of the PBM’s Provider Manual and Agreement. However, despite the pharmacy’s independent efforts to submit the proof of delivery for the claims at issue on two different occasions, the PBM had erroneously refused to accept the documentation, resulting in a large monetary recovery.

With the assistance of effective legal counsel which engaged in further discussions with the PBM’s legal and audit team, the pharmacy was able to demonstrate that the proof of delivery submitted was sufficient. As a result, the PBM reversed the final audit results in full and returned the withheld monies to the pharmacy.

Fortunately, the pharmacy sought Frier Levitt’s assistance to resolve the matters, and through effective representation, Frier Levitt was successful in having the audit findings reversed despite the pharmacy having exhausted the appeals process. Our attorneys are highly seasoned with in-depth experience in all aspects of the PBM industry and can craft thorough responses to erroneous audit findings. Contact Frier Levitt if you are involved in a PBM audit that may implicate further adverse action if left unresolved.