Blog

»  Posts By    

Frier Levitt Helps Florida-based Independent Pharmacy Reduce PBM Audit Recoupment by 90%

A Florida-based pharmacy was facing a $120k audit with a PBM for several different discrepancies, including inventory shortfalls, alleged prescriber and patient denials, and claims submission errors. Frier Levitt worked with the pharmacy to identify the PBM's underlying basis for the audit results. Following the pharmacy's submission of additional documentation and the PBM's review of such information, the audit recoupment amount was reduced to $12k. Frier Levitt also assisted the...

Frier Levitt Saves Texas-Based Pharmacy Over $10k in PBM Audit

Frier Levitt helped a Texas-Based pharmacy facing a PBM audit that alleged the pharmacy had inventory shortfalls due to an issue of drug pedigree. Frier Levitt assisted the pharmacy in conducting an invoice reconciliation to identify that there actually was no shortfall. The PBM was required to reconsider the invoice submitted while clarifying the documentation submitted to demonstrate pedigree was acceptable and appropriate under state and federal law and the...

Frier Levitt Reverses PBM Termination for Texas-based Independent Pharmacy

A Texas-based pharmacy was facing termination from PBM's networks over a $20k audit amount for alleged inventory shortages and overbilled quantities. The PBM was terminating the pharmacy on a small number of errors despite the pharmacy's much larger claims volume. Following an extensive appeal of termination, Frier Levitt was able to reverse the termination. Frier Levitt works with pharmacies facing PBM audits on a routine basis. Contact us today to...

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...

PHARMACY AUDIT ALERT: CVS Caremark Takes Aggressive Position Against Pharmacies for Purchases from “Unauthorized” Drug Distributors

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 pharmacies that "only wholesalers for diabetic supplies that are Authorized Distributors by that manufacturer can be considered for credit." Caremark appears to rely upon a circulation that they issued in June 2016 titled "Audit Tips: Foreign...