Frier Levitt successfully challenged and reversed discrepancies worth $1 million that were identified during an audit conducted by a major pharmacy benefit manager (PBM) against a Georgia-based independent pharmacy. During the audit, the PBM conducted an invoice reconciliation and prescription documentation review. Upon completion of the audit, the PBM alleged drug invoice shortages and prescription related discrepancies totaling over $1 million. After working with the pharmacy to compile requisite documentation to dispute the findings, Frier Levitt submitted a comprehensive appeal response. As a result, the PBM reversed nearly all of the alleged discrepancies and ceased recoupment efforts on those claims.
Pharmacies aiming to stay in-network and protect themselves from harmful financial consequences must prioritize defending against PBM audits and contesting alleged discrepancies. By retaining legal representation and taking prompt action, pharmacies not only avoid significant economic and reputational harm but also ensure uninterrupted and convenient services for their patients.
How Frier Levitt Can Help
Frier Levitt’s life sciences attorneys are highly knowledgeable and experienced in the terminology of various PBM manuals and provider agreements, as well as applicable state and federal laws which regulate the practice of pharmacy. Leveraging their in-depth knowledge, Frier Levitt attorneys are committed to protecting the rights of pharmacies facing unjust PBM conduct and assist them in challenging egregious PBM actions. Contact us if your pharmacy has been subject to an adverse action by a PBM, including unwarranted audit findings, recoupment, and/or network termination/rejection.
