PBM Audits & Defense
Network audits, recoupments, terminations, and appeals against Caremark, OptumRx, Express Scripts, and other PBMs.
HLA’s Latest PBM Win Highlights the Dangers of Inventory Discrepancies
Inventory discrepancies are one of the first things PBMs look for during an audit. Even minor clerical errors like entering the in…
PBM Member Denial Audit Findings: A Growing Threat to Pharmacies
Pharmacies undergoing a Pharmacy Benefit Manager (PBM) audit are typically prepared to address inventory discrepancies and documen…
Defeating Optum: How HLA Won Full Termination Reversals for 7 New York Pharmacies
Health Law Alliance successfully reversed pending terminations for 7 New York pharmacies. Read more about how our PBM audit team a…
HLA Wins Full Reversal of PBM Credentialing Denial for an Independent Pharmacy
This week, Health Law Alliance achieved full reversal of a PBM credentialing denial for a New York pharmacy, mere weeks after it r…
From Prior Authorization to Network Termination: The PBM Audit Trend Independent Pharmacies Must Watch
PBMs are increasingly targeting pharmacies over their role in the prior authorization process, using vague allegations to justify…
Why PBMs are Investigating Provider-Patient Relationships: And What it Means for Your Pharmacy
PBMs are ramping up audit pressure in 2026, now targeting provider-patient relationships to justify recoupments and even network t…
Health Law Alliance Successfully Defends a New York Pharmacy in an Optum Audit
Facing an Optum PBM audit that threatened network participation, a New York pharmacy turned to Health Law Alliance for strategic l…
The Hidden PBM Threat Putting Pharmacies at Risk: Affiliation-Based Network Terminations
PBMs are quietly expanding their power, terminating pharmacies based on affiliation rather than wrongdoing and putting entire busi…
Why Even Minor Documentation Errors Can Be Costly for Pharmacies Facing a PBM Audit
PBMs are using rigid documentation standards to recoup payments and pressure pharmacies. Minor clerical errors can now threaten re…