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
Pharmacy Benefit Managers (PBMs) routinely request that pharmacies submit credentialing and re-credentialing applications, which require pharmacies to provide complete ownership information. In addition, PBMs require that pharmacies identify any... Read More
As Pharmacy Benefit Managers (PBMs) review participation in their retail pharmacy networks, pharmacy providers find themselves at risk of termination over past audit results. We have recently seen a significant increase in a particular PBM... Read More
As Pharmacy Benefit Managers (PBMs) review their retail pharmacy networks and conduct audits, pharmacies find themselves at risk for claim recoupment and audit discrepancies over dispensing ancillary drug products to patients when they did not fill... Read More
As Pharmacy Benefit Managers (PBMs) review participation in their retail pharmacy networks, pharmacy providers find themselves at risk for claim recoupment and termination over improper claim reversals. In conducting audits of network pharmacies,... Read More
In a recent trend, we have seen several PBMs deny pharmacies access to their networks – either through credentialing denials or terminations – following adverse audit findings to steer patients to use PBM-owed pharmacies. For example, when a PBM... Read More
Since CVS Caremark (“Caremark”) introduced the aberrant quantities list (the “List”) in 2019, Caremark has been adding more drug products to the List every year. It now includes nearly 800 drug products and Caremark has been flagging... Read More
As PBMs regularly review claims submitted by pharmacies participating in their retail networks, pharmacy providers can often find themselves at risk for claim recoupment over seemingly minor issues. Frier Levitt recently assisted a California-based... Read More
As a result of the pandemic, many pharmacies have been presented with the opportunity to collect COVID-19 specimens and submit them to laboratories for testing in exchange for payment. Pharmacies that contract with laboratories must be cautious of... Read More
A recent lawsuit and appellate division decision provide guidance to industry stakeholders on copayment assistance programs. Pfizer filed a lawsuit against the U.S. Department of Health and Human Services (“HHS”) Office of Inspector... Read More
