Bad PBM Action of the Month:

Punishing a Small Town Pharmacy for an NPI Mix Up by Cutting Off Billing, Seemingly Indefinitely

Robertson County, Texas is a small, picturesque county just north of College Station (home of Texas A & M). Population 16,958, it’s the last place you’d expect any kind of pharmacy chicanery. So when Leah Allen discovered her pharmacy’s NPI number had been somehow used by another pharmacy to submit claims, she figured the issue would quickly resolve and she’d resume operations as usual.

But of course that didn’t happen.

How the other pharmacy came to use her NPI is still a mystery (not exactly NPI theft or spoofing, no money paid to that submitting pharmacy, no actual evidence of a crime), but even more mysterious is why CVS Caremark hasn’t reinstated Leah’s pharmacy’s access to billing after she fulfilled every request they made as a condition of reinstatement?

“I have complied with everything that has been asked of me,” she says. “I have an audit that they completed where they reviewed 987 total claims and the only findings were 21 invalid prescriptions (that they admit weren’t mine) and 9 drug invoice short ( because I didn’t order drugs for rx’s that I did not fill). They have also stated that those will not be held against me since they don’t belong to me. Therefore I have a completely clean audit.”

Her pharmacy lost billing access over a month ago, and to date has only heard “we’re working on it” when following up.

On CVS Caremark’s website, under “Information for Pharmacists and Medical Professionals / Contact Us (for Healthcare Professionals Only)” it says “Here at CVS Caremark, your needs are important to us. Please do not hesitate to call us directly” but that clearly doesn’t seem to be the case.

CVS Caremark’s unresponsiveness is impacting Leah’s patients, a large percentage of whom are elderly. As CVS takes its time flipping the “on” switch, she’s transferring patient prescriptions in order to ensure they receive their medications. She reports the suspension, now in its 4th week and counting, has had a near-devastating effect on her pharmacy.

So now WE’RE asking CVS Caremark, and we’re going to ask a whole host of others, including Governor Greg Abbott, Senators Ted Cruz and John Cornyn, members of the U.S. Senate and House of Representatives, CVS’ Board of Directors and CVS CEO Karen Lynch just what, exactly is the hold up and why are they punishing patients AND the pharmacy?

Tell us your “Bad PBM” stories — we want to help! Visit the PBM Horror Stories page on our website, or contact us directly at info@truthrx.org.

EDITOR’S NOTE: As we go to publish, we’re happy to report Leah’s pharmacy billing access has been re-instated. PUTT will continue to monitor this and other “Bad PBM” activities and report our findings in the PUTTbulletin.

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Pharmacists United for Truth & Transparency

PUTT is a nonprofit organization dedicated to advocating on behalf of independent pharmacy & fighting against PBM anti-competitive business tactics. TruthRx.org