Frier Levitt recently helped an Arizona-based independent pharmacy that was being audited by a national PBM. The PBM alleged various audit discrepancies including inadequate proof of delivery and missing signature logs. These alleged discrepancies... Read More
A piece of legislation aimed at regulating pharmacy benefit managers (PBMs) and protecting Independent Pharmacies in the State of Tennessee recently passed through the State’s House and Senate and was subsequently signed into law by Governor Bill... Read More
https://youtu.be/sCUAjwc-wdg Frier Levitt’s Jonathan Levitt, Esq. and Lucas Morgan, Esq. talk about PBM Audit Fees in our latest video! Learn about what a PBM audit fee is, what plan sponsors need to know, laws that pharmacies should be aware... Read More
Frier Levitt successfully lifted a payment suspension imposed by a major Pharmacy Benefit Manager ("PBM") upon an independent pharmacy based in New York. The PBM effectuated the payment suspension shortly after conducting an audit but prior to... Read More
Frier Levitt recently assisted a New Jersey-based specialty pharmacy audited by a large health plan and its PBM which had placed over $500,000 at issue through various audit discrepancies, including alleged invalid prescriptions, insufficient proof... Read More
Frier Levitt recently helped a New York-based independent pharmacy that was being audited by a PBM. Frier Levitt worked with the pharmacy and the PBM to successfully reduce the audit discrepancies by more than 90%. The PBM alleged various audit... Read More
As part of standard audits, Pharmacy Benefit Managers (PBMs) routinely request pharmacies to provide documents pertaining to claim submissions, including but not limited to all claims of a specific drug product and any reversed claims. However, in... Read More
Many pharmacies are faced with PBM audits resulting in final audit finding recoupments which can range from very large to very small dollar amounts. Many times, when the recoupment is smaller in sum, pharmacies may be inclined to forgo contesting... Read More
In a recent trend, the Blue Cross and Blue Shield Federal Employee Program (“FEP”), whose pharmacy benefits are administered by CVS Caremark, has been seeking an increasing amount of terminations of network pharmacy providers. Specifically, the... Read More
The current United States marketplace for the regulation of pharmacy benefits is a patchwork of inconsistent (and in some cases non-existent) state laws, state and federal agency regulations, agency manuals and federal laws. Uniform state laws would... Read More
