Pharmacy Benefit Manager (PBM) audits, disputes, and network actions pose some of the most significant financial and operational risks facing pharmacies today. PBMs routinely use audits, credentialing reviews, and contractual enforcement as leverage to recoup payments, suspend reimbursements, and terminate pharmacy network participation. Frier Levitt has spent more than two decades aggressively representing pharmacies nationwide in PBM audits, disputes, and network-related matters, recovering and preserving over $100 million for pharmacy clients across the country.
Defending Pharmacies in PBM Audits and Investigations
Frier Levitt represents pharmacies at every stage of the PBM audit lifecycle, from initial audit notices through appeals, dispute resolution, arbitration, and litigation. The firm regularly defends against on-site and desk audits, invoice and inventory audits, prescription and documentation challenges, copayment audits, and fraud, waste, and abuse (FWA) investigations. Our attorneys understand PBM audit tactics and work quickly to contest improper findings, protect reimbursement, and mitigate downstream risks.
PBM Disputes and Enforcement Actions
PBM audit findings often extend beyond recoupments. Adverse audit results can lead to payment suspensions, adjudication holds, reporting to government agencies, and long-term consequences such as cross-termination or future network removal. Frier Levitt advises pharmacies in challenging these actions, enforcing audit-law protections, and pursuing injunctive relief when necessary to prevent improper clawbacks or termination.
Network Contracting, Credentialing, and Terminations
PBMs increasingly rely on credentialing, recredentialing, and network participation requirements to control pharmacy access. Frier Levitt assists pharmacies with PBM network contracting, credentialing disputes, readmission efforts, and challenges to network termination decisions. We also counsel pharmacies on ownership, affiliation, and operational issues that can trigger cross-termination risk.
Experience That Makes a Difference
Frier Levitt’s PBM team includes regulatory attorneys and pharmacist-attorneys with deep knowledge of pharmacy operations, reimbursement models, and audit law. The firm has successfully overturned audit findings, reversed network terminations, reduced multi-million-dollar recoupment demands, and secured injunctive relief against PBMs on behalf of pharmacies nationwide.
Whether facing a PBM audit, a dispute, or a network threat, Frier Levitt provides strategic, industry-focused legal counsel tailored to your needs. Contact our team today to learn how we can help you.
