Pharmacy Benefit Manager (PBM) Issues

PBM Services

Over the years there has been tremendous consolidation in the healthcare industry; PBMs have been merging with PBMs, and insurance companies has been merging with PBMs. The result is that an increasing number of patient lives are in the hands of fewer administrators. Pharmacies are finding that it is becoming more difficult to gain access to these PBM networks, and once admitted it is becoming increasingly difficult for the pharmacy to adhere to their arduous requirements and to remain in network. Many PBMs even have their own pharmacies, seemingly creating further conflicts of interest. With fewer pharmacies in the PBMs’ network, the market share of pharmacies owned by the PBM increases. Even more money goes to the PBM in such cases. Now more than ever you need to fight to protect your practice and patients from being squeezed out of these PBM networks.

How we Help

Whether its navigating the increasingly complex PBM contracts to become an in-network provider, assisting with audits and appeals, or fighting payment suspensions and contract terminations, The Florida Healthcare Law Firm is uniquely positioned to help your pharmacy with all of its PBM needs.

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