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How to Respond to a PBM Audit Notice

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 […]

Signature Log Audits: Are you Maintaining the Proper Documentation for In-Person and Mail-Delivered Prescriptions?

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. […]

PBM Aberrant Product Lists: The Aberrant NDC and Percentage Billed Compared to Total Volume is Only Part of the Issue

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 […]

Supreme Court Victory for States and Independent Pharmacies

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. […]

PBM Suspension

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 […]

How pharmacy benefit managers squeeze local pharmacists

Opening and operating a pharmacy is difficult enough on its own. In recent years, however, the grip of pharmacy benefit managers (PBMs) is making life even harder for independent pharmacists. PBMs act as a middleman, managing prescription drug benefit programs. PBMs argue they can lower prescription costs by negotiating discounts with large drug companies. What’s […]