Linda Clark, Health Care Controversies Team leader, and Brad Gallagher, counsel, wrote a blog post called “Pharmacies Beware: PBM ‘Concerns’ and ‘Suspicions’ Lead to Network Terminations in Lead Up to SCOTUS Showdown” for The Pharmacy Insider. The post noted:
Pharmacy benefit managers (PBMs) are on the offensive. In recent weeks, PBMs have been aggressively auditing and terminating community pharmacies from their networks, sometimes with limited due process and for relatively minor findings. The practical impact is that these terminations trigger patient communications that often steer patients to the PBMs’ own affiliated pharmacies. . . While advocating for fairness and patient rights, your pharmacy must continue to understand its PBM agreements and associated provider manuals, amendments, and updates that are often faxed, emailed, or placed on a PBMs portal that, for the most part, govern the terms and conditions of your network participation. A pharmacy that does not have a policy to routinely check for changes and continually train its staff is setting itself up for a potentially catastrophic termination and recoupment scenario that could prove be a business and professional disaster.
Read the full post here.