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PBM Termination Archives

Your Rights in a PBM Termination Appeal

We have been seeing a spike in pharmacy benefit management (PBM) network terminations. Termination from a PBM's pharmacy network can be catastrophic to a pharmacy's business. Many PBM terminations are not "for cause." The PBM simply decides to eliminate the pharmacy from its network. Other terminations are initiated after the PBM audits the pharmacy and finds one or two record keeping errors (i.e., where no fraudulent conduct was found). We have been seeing many small discrepancies found in wholesale invoice audits as well that have led to PMB terminations.

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