PBM Audits & Defense
Network audits, recoupments, terminations, and appeals against Caremark, OptumRx, Express Scripts, and other PBMs.
Florida Attorney General Launches Investigation Into CVS Caremark: What It Means for Independent Pharmacies
Florida’s Attorney General issued a Civil Investigative Demand to CVS Health and Caremark, underscoring intensifying scrutiny of P…
Health Law Alliance Successfully Reverses PBM Network Termination for a California Independent Pharmacy
Health Law Alliance obtained a complete reversal of a PBM network termination for a California independent pharmacy, preserving it…
PBM Audit Defense Lawyer Insights: Avoiding the Top PBM Audit Traps That Lead to Network Termination
Six common PBM audit-response mistakes that can escalate into recoupment, network termination, or a broader government investigati…
When to Involve Counsel in a PBM Audit
The audit notice does not announce its own stakes. Which PBM audit decisions actually turn on counsel, and which ones turn on the…
What a PBM Audit Costs an Independent Pharmacy
Recoupment is only one line item. Staff hours, a mid-audit cash-flow offset, and a missed appeal deadline each add their own cost…
Usual and Customary Price Findings in PBM Audits
PBM auditors treat a pharmacy's usual and customary price as a real, enforceable number. Here is how the finding is calculated, tr…
Telehealth-Originated Prescriptions in PBM Audits
PBMs are increasingly recouping on prescriptions written through telehealth, citing invalid prescriber relationships. Here is how…
Signature Log Deficiencies: The Most Common Audit Finding
A missing or illegible signature is one of the most common PBM audit findings pharmacies face, and one of the most recoverable wit…
Self-Auditing Your Pharmacy Before the PBM Does
How pharmacies can sample their own claims, fix the systemic cause behind errors, and document the fix before a PBM audit finds it…