To gain admission to a Pharmacy Benefit Manager ("PBM") pharmacy network, long-term care (LTC) pharmacies are expected to undergo a credentialing process. Generally, the credentialing process for an LTC pharmacy is similar to that of a retail... Read More
In a growing trend, Pharmacy Benefit Managers (PBMs) have taken issue with a pharmacy’s alleged common ownership and/or affiliation with other pharmacies, particularly those that (i) have been previously terminated from the PBM’s pharmacy... Read More
After a pharmacy gains admission into a PBM’s pharmacy network, the pharmacy can expect to receive regular re-credentialing requests. Generally, these re-credentialing requests ask that the pharmacy confirm that the information they previously... Read More
A bipartisan piece of legislation aimed at regulating pharmacy benefit managers (PBMs) in the State of Texas unanimously passed the House and Senate in Texas. Specifically, House Bill (HB) 1763 previously passed the Texas House by a vote of 147-0... Read More
On April 12, 2021, Senator Kolkhorst, along with a bipartisan group of cosponsors, introduced SB 2195, a Bill that prohibits Pharmacy Benefit Managers (“PBMs”) operating in Texas from assessing against pharmacies a variety of different types of... Read More
Pharmacy Benefit Managers (PBMs) routinely request pharmacies to submit credentialing when seeking admission into their networks, and require re-credentialing applications to be submitted two to three years after the pharmacies’ admission. The... Read More
Frier Levitt was recently successful in reversing a Midwest pharmacy’s enrollment application denial by a major Pharmacy Benefit Manager (“PBM”). The PBM denied the pharmacy’s enrollment application alleging that the pharmacy was previously... 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
In a recent trend, the Blue Cross and Blue Shield Federal Employee Program (“FEP”), whose pharmacy benefits are administered by CVS Caremark, has been seeking an increasing amount of terminations of network pharmacy providers. Specifically, the... Read More
