PBMs Increase Scrutiny of Pharmacy-Manufacturer Relationships Renewing Focus on Pharmacy Compliance

Beginning late last year, pharmacy benefits managers (PBMs) broadened their crackdown on specialty pharmacies, including those that the PBMs believed had close ties to particular manufacturers. Using a variety of reasons or guises – including, as in Philidor’s case, improper mail order operations – PBMs have removed several pharmacies from their networks. These actions have brought focus on certain pharmacy-manufacturer relationships, with PBMs publically declaring their targeting of “captive” pharmacies, with a “high proportion of sales” from a particular drug manufacturer.

As a result of these trends, independent specialty pharmacies (particularly those that derive a large portion of their business from one or two therapy lines) need to remain vigilant to comply with PBM network requirements, and take steps to ensure overall compliance. PBMs have relied on technical non-compliance with contractual requirements as a pretext for network termination or other disciplinary action. In addition to assisting pharmacies in ensuring compliance with contractual and legal requirements, Frier Levitt can also assist pharmacies in defending against abusive PBM actions, such as audits or network terminations. Contact us today to speak to an attorney.

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