We are pleased to share a successful outcome for our client, a Florida pharmacy that was denied enrollment and placed under a one-year re-enrollment bar by a pharmacy benefit manager (PBM).

The pharmacy initially submitted its application without legal counsel. Following a review of the submission and an onsite inspection, the PBM raised concerns regarding the pharmacy’s operations, staffing, and affiliated entities. Based on these concerns, the PBM issued a formal denial along with a mandatory one-year re-enrollment bar.

After the pharmacy engaged our firm, we prepared a detailed response addressing each of the PBM’s findings and advocated on its behalf throughout the process. As a result of our intervention and legal representation, the PBM lifted the re-enrollment bar and permitted the pharmacy to reapply for network enrollment immediately.

This result highlights the critical importance of involving experienced healthcare counsel early in the PBM credentialing process to identify potential issues proactively, present accurate and thorough responses, and avoid costly operational delays or business disruptions.

At MDRXLaw, we routinely represent independent, specialty, and retail pharmacies in PBM credentialing, audits, network terminations, and regulatory compliance. If your pharmacy is navigating a PBM denial, audit, or credentialing issue, our healthcare attorneys are available to assist. Contact us by phone at 212.668.0200 or via email at info@mdrxlaw.com to discuss your matter.