Frier Levitt was recently successful in reversing a New Jersey pharmacy’s network termination by a major PBM. The PBM had sent Notices of Termination alleging that the pharmacy failed to comply with terms and conditions of the PBM Provider Manual and Provider Agreement by filling too many specialty claims in retail networks. However, the PBM never provided accurate claims detail of the specialty claims that were allegedly submitted in retail networks.
Frier Levitt attorneys conducted an extensive appeal of the Notices of Termination and met-and-conferred with the PBM’s legal counsel. Thereafter, the PBM advised Frier Levitt that it was rescinding the Notices of Termination and the pharmacy was allowed to continue its membership in the PBM’s network.
Pharmacy providers should be aware that PBMs are terminating pharmacies from their networks based on arbitrary specialty dispensing thresholds. Frier Levitt is well versed in the terms and conditions of PBM agreements, as well as federal and state law pertaining to PBMs. Contact Frier Levitt today if your pharmacy is facing termination by a PBM.
