An Express Scripts (ESI) audit can result in severe challenges to the viability of your pharmacy. Without a strong legal defense, you may face steep penalties and even network termination, a drastic sanction that PBMs are using more frequently to eliminate competition. At Health Law Alliance, we provide specialized legal representation to protect your pharmacy, defend against unjustified recoupments, and hold PBMs like ESI accountable to their obligations under the law.
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Healthcare Specialty Attorneys and Consultants - Health Law Alliance specializes in healthcare law and is dedicated to defending healthcare providers and their licenses from overreach.
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Proven Track Record - The attorneys at Health Law Alliance have a demonstrated track record of success against the most aggressive government regulators and industry behemoths.
Common Questions About Express Scripts (ESI) Audits
Do Express Scripts audits target specific pharmacy types?
PBMs like ESI often unfairly focus on independent, specialty, and compounding pharmacies versus large chains. But all pharmacy types must contend with aggressive Express Scripts audits. Having legal advocates levels the playing field.
Will filing Express Scripts appeals or settlements impact my network contracts?
Retaliation for exercising ESI audit appeal rights is prohibited. We incorporate proper legal protections into Express Scripts audit responses and settlements. Maintaining existing contracts is always a priority.
Can your guidance help prevent future unfair targeting by Express Scripts?
Absolutely. We provide tailored compliance recommendations so pharmacies can reinforce areas prone to ESI audit scrutiny. Proper documentation is critical to rebutting Express Scripts audit allegations.
What recourse exists if advance notice isn't provided?
Lack of proper ESI audit notice may violate the law in many states. We leverage penalties around insufficient notice periods into negotiation leverage for your pharmacy.
Can you help if my license or network participation is jeopardized by an Express Scripts audit?
Yes. We ensure that ESI audit sanctions comply with applicable federal and state laws. PBMs like Express Scripts are prohibited from acting in bad faith or arbitrarily under both applicable law and the parties’ agreements.
What are the costs of legal representation for Express Scripts audits?
We offer flexible fee arrangements based on the scope of representation required and ESI audit stage. The earlier we are involved the better, as we can shape and limit Express Scripts audit scope, making legal representation more effective and less costly.
Speak to an experienced attorney today at no-cost to evaluate your situation and discuss how we can help.
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