Blog

»  Posts By    

Frier Levitt Successfully Reduces Pharmacy’s PBM Audit by Over 97%

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 amount of approximately $174,000. Frier Levitt attorneys submitted additional documents to the PBM, proving that no such mailing had taken place, successfully reducing the PBM audit discrepancy amount by over 97%, from...

New York Governor Signs Bill Providing Independent Pharmacies Greater Audit Protection from PBMs

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 and only permits a PBM to audit a prescription within 24 months after claim submission or adjudication. Furthermore, a PBM can no longer recoup on unintentional clerical errors that do...

Frier Levitt Helps Save Pharmacy Over $390K in PBM Audit

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 purchases by way of cancelled checks. The PBM considered the documents and Frier Levitt was able to help reduce the amount owed by the pharmacy from $394,000 to only $3,800....

Frier Levitt Successful in Rescinding Pharmacy’s PBM Termination

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 was prohibited by the PBM. Despite the fact that the pharmacy agreed to cease and desist mailing, months later the PBM sought to move forward with terminating the pharmacy for...

Pharmacy Audit Checklist: Considerations When Preparing for PBM Audits

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 result. Even though CMS has provided a pharmacy audit checklist, there are some other issues pharmacies should consider before any PBM audit: Common PBM Audit Issues: Is your Pharmacy properly contracted with each PBM based on...