Pharmacies are plagued by the burdens of addressing the terms of their pharmacy benefit manager (PBM) agreements, whether those terms are reasonable or not. Pharmacies are dogged with PBMs wielding their power by initiating a PBM audit – sometimes to root out actual discrepancies, sometimes to injure your business in favor of the PBM’s own affiliated […]
The Arizona State Board has announced an emerging new scam designed to access your money via a transfer of funds request. The scammers claim to be calling from the Arizona State Board of Pharmacy and have even managed to “spoof” some of the Board’s telephone numbers, lending credence to their false claims. Once they have […]
How Saving a Patient Money can Cost Your Pharmacy the Entire Paid Claim Amount or Worse, Your Pharmacy’s PBM Contract. Most who have worked in a pharmacy for some time can remember the Purple Pill Card, the Nexium Savings Coupon with the catchy name and bright purple colors. Not only did this program have catchy […]
Many PBMs relaxed the requirements on signature logs for both in person and delivered medications due to the Covid-19 Pandemic. Some PBMs even allowed mailed prescriptions when otherwise prohibited. While the ease in restrictions made providing patients with their medications easier, the PBMs retained the right to audit signature logs regardless of the lifted restrictions. […]
Billing of Aberrant NDCs Beginning in January of 2020, at least one of the major PBMs began monitoring its network pharmacies for the billing of specific NDC numbers the PBM considered “Aberrant”. The list of NDCs was sent to network pharmacies in November of 2019 and has since been updated in November of 2020. The […]
With the national conversation discussing a Supreme Court of the United States (SCOTUS) that is often highly politicized and characterized as divided, it should be comforting to the independent pharmacy community to know that SCOTUS issued a unanimous, 8-0 (Justice Barrett did not participate in this decision) decision in the case of Rutledge v. PCMA. […]
Payment Suspensions: Why Prompt, Accurate, and Complete Audit Responses are Crucial to Maintaining your Pharmacy Cash Flow. Did you know that your PBM contracts allow for the immediate suspension of your network participation status if the PBM believes you have engaged in or are engaging in any number of possible contract violations? This includes payment […]
Boesen & Snow Law recently assisted an independent pharmacy facing a significant clawback in excess of $300,000 related to a Generic Effective Rate Reimbursement true-up by their PSAO on behalf of a major PBM. Boesen & Snow was able to contest the clawback on behalf of the client and after reviewing the specifics of the […]
The past weeks have left medical providers and health care professionals at risk in more ways than one. In addition to their exposure to contagion, our vital workers may be left exposed legally. Currently, medical providers are working under a patchwork of protections. The result? Ongoing uncertainty and potential for catastrophic and expensive legal suits. […]
A physician’s duty is to their patient. While this is true, medical professionals have many other responsibilities as well. There are hospital and clinic rules that you must follow. You must adhere to state and national regulations, and you have ethical obligations to uphold. Your medical license comes with strings attached. In your pursuit of […]