Recently, a Pharmacy Benefit Manager (PBM) alleged in an audit that a Maryland-based pharmacy had been violating the PBM's network rules of using a third party carrier to mail prescriptions out-of-state to its clients, alleging a total discrepant... Read More
On April 12, 2018, New York Governor Andrew Cuomo signed Assembly Bill A9507C, enhancing oversight and limitations on how PBMs can audit and recoup on pharmacies located in New York. The bill limits PBM audits to 100 randomly selected prescriptions... Read More
Frier Levitt recently assisted an independent pharmacy with an audit after a PBM alleged that several drugs showed a shortfall of inventory. Frier Levitt worked with the pharmacy and reviewed all records of the drug purchases, and provided proof of... Read More
Early this year, an independent pharmacy received a notice from their PBM demanding that the pharmacy immediately cease and desist mailing to their members. The notice alleged that the pharmacy had been engaged in mailing on a retail contract, which... Read More
From recoupments and network terminations, to governmental investigations, pharmacies face serious PBM risks when issues that arise in audits are not properly addressed. Preparation and preventative measures are key to ensuring a positive audit... Read More
In a recent but aggressive trend, CVS Caremark (Caremark) has begun to audit and subject pharmacies across the nation to recoupment for purchases from allegedly "unauthorized distributors." Specifically, Caremark has taken the position against... Read More
Many states have enacted legislation to reform the business practices of the Pharmacy Benefit Manager (PBM) industry. For example, a number of states have enacted such laws as the Fair & Uniform Pharmacy Audits, PBM Regulation/Transparency, and... Read More
In a recent but aggressive trend, Express Scripts, Inc. (ESI) – the nation's largest Pharmacy Benefits Manager (PBM) – has begun auditing and recouping large sums of money from pharmacy providers stemming from drug purchases made from allegedly... Read More
In a civil complaint filed December 15, 2016, 20 State Attorneys General accused six generic drug companies, including Teva Pharmaceuticals and Mylan, of engaging in price-fixing schemes. The complaint alleges that the companies conspired to... Read More
In the wake of the recent litigation involving Abbott Laboratories and "gray market" diabetic test strips, pharmacies are facing increased PBM scrutiny over their purchases from certain pharmaceutical distributors, including secondary wholesalers.... Read More
