As part of routine audits, Pharmacy Benefit Managers (“PBMs”) regularly request pharmacies to produce documents pertaining to prescription claims. Amongst the documents commonly requested are copies of prescriptions, prescription labels, and... Read More
Frier Levitt recently assisted a New York-based independent pharmacy that was placed under temporary payment suspension by a national Pharmacy Benefit Manager (“PBM”). Notably concerning, the temporary suspension was effectuated while the... Read More
In Wisconsin, Governor Tony Evers recently signed a bipartisan bill into law aimed at regulating pharmacy benefit managers (PBMs). This law, which was unanimously passed in the Wisconsin legislature, is significant for several reasons including... Read More
Independent pharmacies face numerous challenges and obstacles when being audited by pharmacy benefit managers (PBMs). One audit related tactic utilized by PBMs that is causing financial harm to independent pharmacies throughout the country is the... Read More
One of the most challenging issues for independent pharmacies throughout the United States is the issue of pharmacy benefit managers’ (PBMs) reimbursement practices. There are numerous ways in which PBMs dictate reimbursement to independent... Read More
Throughout the country, several states have engaged in ongoing efforts to enact or enhance state laws aimed at regulating pharmacy benefit managers (PBMs) and certain PBM practices, including audit and reimbursement practices, causing economic harm... Read More
In a recent trend, pharmacies have begun receiving notices of termination not for billing errors or audit findings, but for claims inactivity. Specifically, several Pharmacy Benefit Managers, or PBMs, have been terminating pharmacies solely because... Read More
Many pharmacies are faced with PBM audits resulting in final audit finding recoupments which can range from very large to very small dollar amounts. Many times, when the recoupment is smaller in sum, pharmacies may be inclined to forgo contesting... Read More
"Pharmacy Benefit Managers, or PBMs, have a major say in determining prescription drug prices and availability, but few people—including doctors—understand these organizations or what they do." Frier Levitt Co-Founding Partner, Jonathan... Read More
Many states throughout the country have enacted various laws aimed at protecting independent pharmacies from improper and predatory practices by pharmacy benefit managers (PBMs). One example of a state with aggressive laws aimed at protecting... Read More
