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August 28, 2019

Barclay Damon Helps Pharmacy Avoid PBM Recoupments for "Advisory" Prescriptions

Barclay Damon successfully appealed a PBM’s audit findings related to “advisory” prescriptions on behalf of a NY pharmacy. 

The electronic prescriptions that were sent to the pharmacy failed and were then converted to fax prescriptions, which are considered “advisory only” under NY law. As required, the pharmacy confirmed the prescriptions with the provider at the time of receipt but did not record all of the necessary administrative notes. Relying on the NY pharmacy audit protection statute and its knowledge of PBM audit procedures, Barclay Damon was able to successfully establish the errors were clerical in nature and had the findings reversed. This resulted in the pharmacy avoiding a large recoupment and chargeback fees for the cost of the audit.

Barclay Damon has successfully represented pharmacies across the nation in PBM audits. Coupled with our attorneys’ experience with PBMs, our knowledge of the rapidly changing legal landscape has allowed us to assist clients with saving tens of thousands in recoupments and chargeback fees as well as avoiding potential termination for contractual violations.

If you have any questions regarding the content in this alert or if your pharmacy is facing a PBM audit or termination, contact Linda Clark, health care controversies team leader, at lclark@barclaydamon.com or Brad Gallagher, counsel, at bgallagher@barclaydamon.com or another member of the firm’s health care controversies team.

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