Magazine article Drug Topics

Pick Your Poison: N.Y. R.Ph.S Blame PBMs for Dilemma

Magazine article Drug Topics

Pick Your Poison: N.Y. R.Ph.S Blame PBMs for Dilemma

Article excerpt

Here's the scenario: Sometime after leaving your store, an auditor calls to say he needs additional information to complete his report. He won't be visiting you again, so he'd like you to send photocopies of the patient records in question. Do that, and you'll jeopardize your license by violating the privacy laws in the state where you practice. Refuse to send the documentation, and you might forfeit some $28,000 in claims.

What do you do?

It is not a hypothetical question, according to the Pharmacists Society of the State of New York (PSSNY). "This has caused a firestorm in the state, and I'm sure we're not the only ones," said Craig Burridge, PSSNY executive director.

Burridge told Drug Topics that some auditors, working on behalf of pharmacy benefit managers, are exploiting confidentiality laws in the state to collect funds related to disputed claims from pharmacists put in a no-win situation. Now PSSNY is gathering information for a possible lawsuit. "The pharmacist's license should not be put in jeopardy" by third-party auditors, Burridge emphasized.

However, PCS Health Systems, identified by PSSNY as one of the PBMs whose auditors make such demands, said it provides alternative means for New York pharmacists to document claims after a field audit. …

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