Pharmacies are urged to take immediate steps to challenge PharmacyFirst's actions in connection with so-called "GER" adjustments. GER ("Generic Effective Rate") provisions were added in the past year to agreements between Caremark and PSAOs, including PharmacyFirst (formerly, Third Party Station). GER is thought to be the commercial plan equivalent of DIR fees. We see that, without any input from member pharmacies or an opportunity to protest or challenge, pharmacies started receiving GER reconciliation reports showing, in some cases, hundreds of thousands of dollars due to Caremark for claims dating back to January 1, 2018. PharmacyFirst is believed to have started withholding GER adjustments from monies due to pharmacies from Caremark.
Our firm is at the forefront of helping pharmacy clients and other providers to deal with various PBM and PSAO issues, including GER deductions. We have developed effective approaches to most situations that arise in the context of PBM/PSAO/Pharmacy disputes. Call or text us at 212-668-0200 or email at email@example.com to have us evaluate your situation.