Frier Levitt recently helped a Florida based pharmacy reverse a purported network termination by a major PBM. The PBM had sent a Notice of Termination alleging that the pharmacy would be terminated due to inventory shortages identified during a recent desktop audit. Notably concerning, the PBM issued the Notice of Termination based solely on inventory shortages that resulted in a seemingly insignificant overpayment amount.
Frier Levitt’s Life Sciences attorneys Dae Y. Lee, Pharm.D., Esq. and Adam C. Farkas, Esq. conducted an extensive appeal of the termination and advanced the matter towards meet-and-confer with the PBM’s legal counsel. As part of the extensive appeal, Frier Levitt developed and helped implement a robust corrective action plan (“CAP”) specifically tailored to address the underlying issues which led to the pharmacy’s purported termination. Before the meet and confer became necessary, the PBM informed Frier Levitt, that solely based on the appeal of the termination and CAP, it will reverse the Notice of Termination.[1]
As discussed in our recent article, pharmacies are facing heightened scrutiny by major PBMs, including network terminations based off of seemingly insignificant audit findings which seek to recoup relatively small amounts of money. Therefore, pharmacies must be diligent in combating all PBM audit findings, regardless of the amount at stake, to avoid potential adverse PBM action, including network termination.
How Frier Levitt Can Help
Frier Levitt’s Life Sciences attorneys are well versed in the terms of various PBM Manuals and Provider Agreements as well as applicable State and Federal laws which regulate the practice of pharmacy. Frier Levitt leverages that knowledge to effectively protect the rights of pharmacies who are unfairly targeted by PBMs and assist pharmacies in implementing corrective measures in the form of policies and procedures or an extensive Corrective Action Plan to ensure your pharmacies compliance with relevant laws, regulations, and PBM terms and conditions. Contact us today if your pharmacy has been subject to an adverse action by a PBM including unwarranted audit findings, recoupment, and/or network termination.
[1] The Pharmacy was already terminated by the PBM at the time the Pharmacy engagement Frier Levitt. The PBM ultimately agreed to allow the Pharmacy to reapply to the PBM’s pharmacy network without any waiting period.
