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 “Member Denials,” which were the basis for the PBM’s
decision to terminate. The pharmacy operates in all 50 states and had armed itself with
processes that produced documentation of its compliance with the PBM’s provider manual.
Upon the successful presentation of the evidence and legal arguments to the PBM’s Appeal
Hearing Committee, the PBM promptly rescinded the termination decision, and the pharmacy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
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.
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