Boesen and Snow recently secured the reversal of a major PBM’s decision to terminate a pharmacy from its network. Before the reversal, the PBM had rejected the pharmacy’s documentation refuting the audit findings and had quickly issued its termination letter.
Boesen and Snow collaborated with the pharmacy client to obtain and provide overwhelming evidence to refute and overturn the “Drug Invoice Shortages,” which were the basis for the PBM’s decision to terminate. The pharmacy had conducted minimal pharmacy to pharmacy transfers of product due to patient specific prescriptions between a commonly owned pharmacy and the audited pharmacy. The PBM questioned the transfer of product and determined the audited pharmacy to be “short” on the medications reviewed. Upon the successful presentation of the evidence and legal arguments to the PBM’s Audit Team, the PBM rescinded the termination decision, and the pharmacy was allowed to remain in network.
PBM terminations due to audit findings are exceedingly difficult to overcome. Many pharmacies attempt to respond to PBM audits without the help of experienced attorneys and can put themselves at a severe disadvantage for the remainder of the audit and any appeal process.
Boesen and Snow leverages its unique background of over 20 years of combined pharmacy and PBM operational experience and extensive litigation experience at the highest level of the regulatory industry to defend pharmacy clients during PBM audits and termination hearings.
Contact Boesen and Snow Law immediately if your pharmacy has been notified of an audit or is threatened with a PBM termination.