PBM Disputes and Arbitration

For an independent pharmacy, a dispute with a pharmacy benefit manager can mean clawed-back reimbursement or the loss of network access. The provider agreement usually controls how the dispute is heard, and often requires arbitration.

We represent pharmacies and pharmacy groups in matters including:

• Audit findings and recoupment demands

• Network terminations and exclusions

• Reimbursement and payment disputes

• Internal appeals and contractual arbitration

• Challenges to extrapolation and audit methodology

We look for weaknesses in the audit, in the contract and in the PBM's own process, and we pursue the outcome that protects your pharmacy's revenue and network position.