In the healthcare industry, there are many safeguards put in place to protect patients. When it comes to medication and pharmacies, it is no different. PBM pharmacy audits are conducted both for the sake of the pharmacy benefit manager (PMB) and for you, the pharmacy owner. A PBM audit can be a stressful experience for a pharmacy, especially a small, independent one, but many pharmacies cannot operate at desired capacity without also working with a PBM. If you have an upcoming PBM pharmacy audit, proper preparation is key to success.

Documentation is Extremely Important

For many pharmacies, but especially independent pharmacies, documentation is often an area that needs attention. When your PBM auditor comes to your pharmacy, they may request to see certain documentation that could be from months or even years ago. This documentation could be anything to do with things such as supply changes, such as going from a 30-day supply to a 60-day supply, or early refills. Having your documentation completed, thorough, and organized will save you much stress during the audit.

Consistency Is Expected

Part of the job of a PBM auditor is to make sure that each patient receives the same standard of care when they use your pharmacy. This is accomplished by making sure that all employees are following the same rules and policies while they perform their job. When your PBM auditor is at your pharmacy, they will be looking for any errors made by your staff, such as checking the amount of medication dispensed or ensuring all of the proper forms and documentation are filled out. It is a good idea to have an official standard operating procedure (SOP) written out and distributed to all of your employees so that they understand what is expected of them every time they fill a prescription.

To become a pharmacist, a person has to go through many years of schooling, pass dozens of tests and complete thousands of hours of an internship. Becoming a pharmacist is a huge accomplishment; to have that all taken away from you can be devastating. There are many reasons why your pharmacist license might have been taken away. Perhaps you got into trouble for illegally distributing controlled substances. Or maybe you made an error in a prescription that you filled for a patient. Whatever the reason, having your ability to practice taken away can be disheartening. However, there are steps you can take to have your license reinstated.

Reinstating Your Pharmacist License

In most cases, it is possible to have your pharmacist license reinstated if it has lapsed into the inactive status. The process of reinstatement will look different depending on the length of time that has passed since the license was inactive status. Depending on the time that has passed, your requirements for reinstatement will be slightly different.

If Your License Has Been Inactive for Less Than Five Years

According to the Pharmacy Practice Act, a pharmacist whose license has been inactive for less than five years can restore their license if they do one of the following:

For many people, the American dream is owning your own business. For some pharmacists, that dream involved starting, owning and growing their own independent pharmacies. According to statistics from the National Community Pharmacists Association (NCPA), there were more than 22,000 independent pharmacies operating in the U.S. in 2015. Of those, an estimated 1,000 pharmacies will change ownership each year.

Buying and selling a pharmacy is a different and more complicated process than buying and selling most other businesses. With a pharmacy, you must pay attention to certain things when transferring ownership, such as informing and coordinating with drug suppliers and vendors, ensuring the pharmacy is enrolled as a provider for Medicaid, Medicare, and supplemental plans and various other things. If you are looking to sell your pharmacy, here are a few things you should keep in mind:

• Have a legitimate exit strategy and timeline in place. Too many times pharmacy owners do not have a plan when it comes to the sale of their pharmacy and things do not turn out for the best. If you are thinking of selling your pharmacy, set a date of when you would like to have the sale completed. Then you will have a rough idea of when certain tasks should be completed by. In general, it can take several months or even years to complete a sale.
• You should have your finances in order before you start looking for potential buyers. Whoever is interested in buying your pharmacy will want to look at at least the past three or four years of business record, including audited financial statements, profit and loss statements, balance sheets, corporate tax returns, and prescription sales logs. This allows your prospective buyer to determine whether or not the business is a good investment for themselves.
• Make your pharmacy as attractive as possible to potential buyers. This includes the physical appearance of your pharmacy. Think of home sales; a person selling their home is not going to host an open house until their home looks as good as it possibly can look. Even just a new coat of paint or new flooring can transform a business and make it look more appealing to a buyer.
• Make sure all your contracts and licenses are up to date. You should be sure that your reimbursement contracts with third-party payers are available and up to date so that potential buyers can review them. This includes any local business license, state pharmacy licenses or building permits.

Contact an Illinois Pharmacy Sale Attorney Today

When it comes to selling a pharmacy, there are many things you should keep in mind before and during the process. There are many considerations to remember during a pharmacy sale, especially that selling your pharmacy is not as simple as signing over ownership to another person. At The Law Offices of Joseph J. Bogdan, Inc., we have been helping clients successfully buy and sell pharmacy businesses for more than 16 years. One of our skilled Illinois pharmacy sale lawyers is a licensed pharmacist and has extensive knowledge of both the medical and legal fields. Call our office today at 630-310-1267 to schedule a consultation.

The world of healthcare is constantly changing. For some pharmacies, keeping up with these changes can be difficult, particularly for independent or small pharmacies. The Centers for Medicare and Medicaid Services (CMS) is the governing body that oversees the practices of different medical professionals who provide services covered by Medicare and Medicaid. One of the goals of CMS is to try to cut down on healthcare fraud and they do this by conducting audits to ensure providers operate within the legal standards. CMS audits can sometimes produce less-than-favorable results that could seriously affect the operation of your pharmacy and its financial wellbeing. Here are a few things you and your employees can do to minimize any errors or inadvertent fraudulent practices:

• Ensure you are meeting requirements for both non-controlled and controlled substances. When filling and dispensing a prescription, there are certain pieces of information that you must collect, plus a few special pieces of information for controlled substances. To fill a prescription, you must have the prescriber’s signature on the prescription, the name, strength and dosage form of the drug, the directions for use and the number of pre-authorized refills (if any). For controlled substances, the prescriber must have the appropriate authority to prescribe such a drug and the prescriber must manually sign the prescription on the date it was issued.
• Follow proper procedures for prescription dosages that exceed the Food and Drug Administration (FDA) guidelines. If you or your employees notice that a drug has been prescribed an unusually high dosage or in a dosage that exceeds the FDA’s recommendations, you should first check the drug’s dosage guidelines on one of the online references. If the dosage does, in fact, exceed FDA guidelines, you should contact the prescriber to verify the dosage amount. Be sure to get a hard copy of all communication regarding dosage and include the patient’s diagnosis and the prescriber’s reason for overriding the dosage guidelines.
• Ensure your employees properly document when a beneficiary receives his or her prescription. This is one of the rules that exists to ensure the chain of possession is accurate. When you fill a prescription for someone, you must document that they received their prescription. Maintaining an accurate signature log can help you avoid accusations of fraud.

An Illinois Medicare Pharmacy Audit Defense Lawyer Can Help

Before you are subject to a field audit, CMS will notify you of the date, giving you time to prepare and ensure things are in good working order. A CMS audit can be extremely important -- consequences of a negative audit can range from a simple warning or monetary fine to forfeited CMS reimbursements. At The Law Offices of Joseph J. Bogdan, Inc., we can help you prepare for an upcoming CMS audit or we can help you challenge the results of an already completed audit. Get in touch with our knowledgeable Illinois Medicare pharmacy audit defense attorneys today to begin talking about your case. Call our office at 630-310-1267 to schedule a free consultation.

If you are a healthcare provider that prescribes controlled substances, you are being monitored by the Drug Enforcement Administration (DEA). Due to the potential for illegal activity in the pharmacy business, DEA inspectors visit pharmacies to ensure that they are complying with all regulatory standards. If the DEA pays a visit to your pharmacy, it is important to react in a calm and professional manner. Still, a DEA investigation can lead to harsh punishments and even license revocation. If you are facing a DEA investigation, contact a license defense attorney that you can believe in.

Preparing for a DEA Visit

Due to the implementation of the Controlled Substances Act, the DEA is allowed to inspect a pharmacy, investigate the receiving and distribution of controlled substances, and even take substance samples. How you react to a DEA visit can make all the difference in ensuring that the investigation goes smoothly.

Be Respectful: When the DEA arrives at your pharmacy, for an inspection, it is easy to feel attacked, and become flustered. As the inspectors arrive, being kind and respectful can set the investigation off on the right foot. All that considered, it is also important to understand your rights. A DEA inspection can only take place with your consent. If the inspection is not being conducted during standard business hours, or there is not proper personnel on site, you can request for the inspection to take place at a different time.