PHARMACY PROVIDER ALERT: Pharmacies Should Be Aware of a New Trend Requiring Maintenance of a Copy of Member ID card

PBM audits often follow certain trends which vary and evolve. One potentially emerging trend Frier Levitt has observed is that pharmacies who are undergoing audits with certain PBMs, namely OptumRx, are being asked to provide an actual copy of the member ID card for purposes of audit. OptumRx does not articulate such a requirement to store a copy of the Member ID card anywhere in its Provider Manual, rather it merely requires that a Network Pharmacy Provider check the Member’s ID card at each visit. Many pharmacies may not be aware of this new trend, however, and pharmacies undergoing OptumRx audits may have their paid claims subject to reversal if the Pharmacy has not maintained a copy of the Member ID card. It is important that pharmacies know their rights. If you would like to file a dispute or simply learn more about your PBM contracts and legal rights, contact Frier Levitt to speak to an attorney.

Share: