Pharmacy Alert: Caremark Ramps Up Re-Credentialing Requests

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 provided to the PBM remains accurate. For example, such requests for information could be as rudimentary as contact information and hours of operation, but could be more inquisitive as to whether there have been any changes of ownership, management, or employees. Further, PBMs could inquire as to whether or not the pharmacy has been terminated from any other PBM or payor network since the time of credentialing or since the last re-credentialing submission. When providing responses, pharmacies should not only be conscious to provide accurate information, but should also be sure to provide clarifying context to the extent there are responses that may present the pharmacy in a negative light (many times, re-credentialing applications provide opportunity to expand upon what otherwise might be simple “yes/no” questions). If a pharmacy fails to timely submit re-credentialing information to the PBM, the pharmacy could be subjected to further action, including termination.

Recently, pharmacies have reported that CVS Caremark has issued new blanket re-credentialing requests, regardless of when the pharmacies last re-credentialed.  Several pharmacies have reported being required to re-credential only ten months after their last re-credentialing submission. This is particular cause for concern where PBMs require “periodic re-credentialing,” which has historically been once a year. Importantly, at the time of re-credentialing, many PBMs may also request that pharmacies sign a new or updated provider agreement that may subject pharmacies to additional terms and conditions they were not previously required to adhere to. Pharmacies should cautiously address all re-credentialing requests (even premature ones) to ensure that they duly answering all questions, and being aware of changes in the terms of their network participation.

How Frier Levitt Can Help

If your pharmacy has received a PBM re-credentialing request, contact Frier Levitt to speak to an attorney today on how the pharmacy can best address the request. Similarly, if your pharmacy is seeking admission into a particular PBM network, speak to one of our experienced attorneys to help your pharmacy through this process.