Frier Levitt recently assisted a Virginia-based physician dispensing practice client in challenging and completely overturning 100% of the alleged discrepancies asserted by a major Pharmacy Benefit Manager (“PBM”) in its audit findings.
In the audit, the PBM largely focused on the dispensing of Venclexta, a single-package oncology medication. The PBM alleged that the practice billed an “invalid quantity” because the medication is supplied as an unbreakable package and the practice was breaking the package and dispensing multiple fills from the original packaged bottle. However, Frier Levitt established that the dispensing was in full accordance with manufacturer’s instructions, with no evidence of product adulteration, patient harm or deviation from appropriate dispensing practices. Furthermore, Frier Levitt was able to demonstrate that there was no financial difference to the PBM or its plan sponsors by virtue of how the prescriptions were dispensed and that practice, in fact, may have yielded cost savings to the PBM and its plan sponsor clients.
Beyond the discrepancies attributed to dispensing Venclexta claims, the PBM also cited to several additional discrepancies, including “unauthorized refill,” “no signature log/proof of delivery,” “incorrect DAW code,” and “incorrect days supply.” Frier Levitt was able overturn each of these findings by demonstrating that these issues were either minor clerical errors or contradicted by supporting documentation verifying the prescription’s accuracy, authorization, and dispensing.
Importantly, this result aligns with other similar audits with physician dispensing practices involving Venclexta, where Frier Levitt also secured full reversals of the audit results. These consistent outcomes reflect the importance of understanding both the clinical and operational considerations unique to specialty/oncology drug dispensing, particularly as it relates to challenging PBM audit findings. PBMs have increased their audits of physician dispensing practices but have ignored the unique nature of physician dispensing practices of having the dual responsibility of being the prescriber and the dispenser of a medication.
How Frier Levitt Can Help
If your dispensing physician practice is currently being audited or has recently received audit findings related to the dispensing of Venclexta, single-package quantity disputes, or other similar PBM allegations, Frier Levitt can help. Contact us today to speak with an attorney. We have several pharmacist attorneys that can provide specialized representation on clinical issues raised in PBM audits.
Frier Levitt provides strategic, industry-focused legal counsel tailored to your needs. Contact our team today to learn how we can help you.
Senior Counsel
