Three years ago, many PBMs enacted exceptions and waivers to their respective Provider Agreements and Manuals that would have otherwise limited the ability of participating pharmacies to provide services by way of mail to members during the COVID-19... Read More
Antitrust Tools Available to Combat PBM Abuse of Pharmacies | Articles | Chain Pharmacies | Community, Retail Pharmacies | Defending Pharmacies in PBM Audits | Digital Pharmacies | Fertility Pharmacies | Long-Term Care Pharmacies | Specialty Pharmacies | Supermarket Pharmacies

Frier Levitt helped a New York pharmacy successfully appeal initial audit results in their entirety that were issued by a large PBM. Despite the pharmacy’s submission of purchase information directly from its wholesalers, the PBM alleged... Read More
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A major PBM has recently begun issuing notices to pharmacies stating that they have been identified as having “atypical” dispensing activities during period claim reviews. Although these notices are not related to a formal audit, the PBM still... Read More
Articles | Chain Pharmacies | Community, Retail Pharmacies | Defending Pharmacies in PBM Audits | Digital Pharmacies | Fertility Pharmacies | Long-Term Care Pharmacies | Specialty Pharmacies | Supermarket Pharmacies | Traditional Compounding Pharmacies (503A)

An Ohio-based pharmacy client was recently placed on payment suspension due to alleged inventory shortfalls during a Pharmacy Benefit Manager (“PBM”) audit before initial audit results were even issued, leaving the pharmacy with limited to no... Read More
Articles | Defending Pharmacies in PBM Audits | News | Recent Results | Recent Successes

In the course of pharmacy audits, PBMs are increasingly requesting from pharmacies copies of Drug Supply Chain Security Act (“DSCSA”) track and trace documents, commonly known as “T3” documentation. The T3, which consists of the Transaction... Read More
Articles | Community, Retail Pharmacies | Defending Pharmacies in PBM Audits | Digital Pharmacies | Fertility Pharmacies | Home Infusion Providers | Integrated Delivery Network and Hospital System Pharmacy | Long-Term Care Pharmacies | Specialty Pharmacies | Supermarket Pharmacies | Traditional Compounding Pharmacies (503A)

Rising drug prices have forced consumers to seek out and utilize the most affordable sources to obtain their prescription medications. Whether it’s through commercial insurance, prescription discount cards, or manufacturer assistance programs,... Read More
Antitrust Tools Available to Combat PBM Abuse of Pharmacies | Articles | Chain Pharmacies | Clinically Integrated Networks (CINs) | Community Oncology Practices & Other Dispensing Physician Practices | Community, Retail Pharmacies | Defending Pharmacies in PBM Audits | Digital Pharmacies | Fertility Pharmacies | Hospitals and Healthcare Systems | Integrated Delivery Network | Integrated Delivery Network and Hospital System Pharmacy | Physician Dispensing | Regulatory Compliance, including FDA, DEA and HIPAA | Risk Assessment Mitigation Strategy | Specialty Pharmacies | Supermarket Pharmacies | Traditional Compounding Pharmacies (503A)

Last month, several pharmacies participating in a major PBM’s networks received notices about their Hub relationships. Pharmacies were reminded of their inability to enter into Hub arrangements without prior consent from the PBM and were directed... Read More
Articles | Chain Pharmacies | Community, Retail Pharmacies | Defending Pharmacies in PBM Audits | Digital Pharmacies | Fertility Pharmacies | Integrated Delivery Network and Hospital System Pharmacy | Payor Network Access and Defense of Network Terminations | Specialty Pharmacies | Supermarket Pharmacies | Traditional Compounding Pharmacies (503A)

Frier Levitt recently assisted a Florida-based retail pharmacy in overcoming a substantial number of discrepancies raised during a PBM audit. The PBM alleged that the pharmacy had several discrepancies, including invalid proof of a patient’s... Read More
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