PBM Audits & Defense
Network audits, recoupments, terminations, and appeals against Caremark, OptumRx, Express Scripts, and other PBMs.
Negotiating a PBM Audit Settlement
A PBM audit settlement should resolve the recoupment, the payment plan and the pharmacy's network status as separate, written term…
State PBM Reform Laws in 2026: What Changed for Pharmacy Audits
Oklahoma and Delaware enacted 2025 and 2026 laws that bar PBM audit extrapolation, cap how often pharmacies can be audited, and sh…
OptumRx Audit Appeals: What to Submit and When
A preliminary OptumRx finding is only the start. State law sets real deadlines for what a pharmacy must submit, and when, before t…
Caremark Audit Discrepancy Codes Explained
Caremark's Provider Manual sorts every audit discrepancy code onto one of two tracks: resolvable with a specific document, or alre…
Limited Distribution Drugs and Pharmacy Access
Manufacturers, not regulators, decide which pharmacies may dispense a limited distribution drug, and exclusion carries real audit…
PBM Annual Attestations and FWA Training: Signing Accurately
Network pharmacies sign a yearly PBM attestation on FWA training, exclusion screening, and policies. An inaccurate signature creat…
Types of Pharmacy Audits and Who Runs Each One
PBM, Medicare Part D, state Medicaid, DEA, board of pharmacy, and manufacturer REMS audits each run on a different authority and r…
CVS Caremark Pharmacy Audits: A Preparation Checklist
A checklist for the window between a CVS Caremark audit notice and the document due date, drawn from the current Caremark Provider…
REMS Requirements for Pharmacies: Certification, Checks and Audits
A Risk Evaluation and Mitigation Strategy can require pharmacy certification, an authorized representative, staff training, and a…