The Law Offices of Joseph J. Bogdan, LLC



What You Should Know About PBM Pharmacy Audits in Illinois

Posted on in Pharmacy License Defense

IL license defense lawyerIn 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.

PBM’s Can Terminate the Contract

Lastly, it is important to remember that PBM’s actually hold quite a bit of power. In most contracts between PBM’s and pharmacies, the PBM is able to terminate the contract with or without cause. If your contract with your PBM is terminated, you will be notified, usually by mail. Most of the time, a reason will be specified when the termination is announced.

Speak with an Illinois PBM Pharmacy Audit Defense Lawyer

For independent pharmacies, especially, a PBM pharmacy audit can be extremely stressful and in some cases, financially straining. If your pharmacy has been audited by your PBM and certain areas were flagged for noncompliance, you should speak with a skilled Illinois PBM pharmacy audit defense attorney. At the Law Offices of Joseph J. Bogdan, LLC, we can also help you prepare for a PBM audit if you have not yet had one conducted. To schedule a consultation, call our office today at 630-310-1267.



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