UPDATE: PBMs Have Slowly Begun to Lift Certain Flexibilities Implemented During COVID-19 While Extending Other Relaxations in Policies and Procedures

As a result of the COVID-19 pandemic, many Pharmacy Benefit Managers (“PBMs”) had taken some form of action to help prioritize patient care including providing safe access to prescription drugs. Many of the flexibilities and changes in policy that had been put in place by PBMs to address the COVID-19 emergency thus far, as previously discussed in the following blogs ( What Are the PBMs Doing Amid COVID-19 Crisis: Waivers from Strict Requirements May Exist for Independent PharmaciesUPDATE: Humana and Prime Therapeutics’ Response to Waivers from Strict Requirements for Independent Pharmacies Amid COVID-19 Crisis and UPDATE: Many PBMs Have Continued to Add or Extend Relaxations During COVID-19 ) have been scaled back while others have been extended until further notice or for the length of the public health emergency.
Certain PBMs such as Humana have announced that requirements for signature logs, proof of delivery, and mailing waivers have been extended for the duration of the public health emergency, and that pharmacies will be notified when relaxed standards end. In the same vein, MagellanxRx has also updated its previous proof of delivery relaxation with respect to  “COVID-19” documentation as acceptable to now indicate that pharmacies are required to have policies and procedures on the waiver in effect, and that it shall be made available to PBM upon request until further notice. However, despite the ongoing pandemic and the growing concern for the rise in number of cases in many states throughout the country, PBMs such as MedImpact and OptumRx decidedly announced that audits will resume. MedImpact has specified that virtual onsite audits will begin on August 1, 2020. OptumRx has stated that it will start up desktop and virtual onsite audits as of August 1, 2020.

How Frier Levitt Can Help
Frier Levitt is actively assisting pharmacies seeking waivers from State Boards of Pharmacy, PBMs and CMS during these challenging times and is monitoring these changes so that we can continue to provide you with timely updates as circumstances change. For more information on how to address these PBM practices, contact us to speak with an attorney.

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