Inside the PBM Machine: PBM Audits, Compounding, TrumpRx

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What happens when GLP-1 compounding, TrumpRx, and PBM audits all collide in your pharmacy?

In this episode of the Bottom Line Pharmacy Podcast, hosts Austin Murray and Bonnie Bond, CPA, are joined by healthcare attorney Dae Lee of Buchanan, Ingersoll, & Rooney, P.C. to unpack the fast-moving legal and regulatory landscape around GLP-1s, PBMs, and audits and what independent owners need to be doing right now to protect their businesses.

We cover:

- The vertical integration behind the “big three” PBMs and their rebate aggregators
- Why PBM audit triggers and the realities of today’s audit tactics
- A practical roadmap for responding to an audit
- What “recredentialing season” really means
- TrumpRx

And more!

More About Our Guest:

Dae Y. Lee, Pharm.D., Esq., CPBS focuses on representing pharmacies in their dealings against Pharmacy Benefit Managers (PBMs). With extensive experience in the intricacies of PBM audits, investigations, network enrollment, network suspension, network terminations, reimbursement disputes, and DEA as well as other governmental investigations, Dae has become a trusted advisor to a broad cross-section of pharmacies and pharmacy providers, including community retail pharmacies, chain pharmacies, compounding pharmacies, specialty pharmacies, mail order pharmacies, home infusion providers, and dispensing physician practices.. His practice also extends to assisting other stakeholders in the pharmacy industry such as wholesalers, manufacturers, and other healthcare providers.

In addition to his PBM-focused work, Dae represents entities in pharmacy-related transactions and assists clients with corporate formation, due diligence, licensing, change-of-ownership requirements and credentialing, providing comprehensive legal support throughout the transaction process.

Dae is a Certified Pharmacy Benefits Specialist™ (CPBS™). Offered through TransparentRx and accredited by the University of Kentucky School of Pharmacy, the CPBS program is designed to cover complex topics of pharmacy benefit management in order to provide a foundational knowledge required for higher-level evaluation of PBM business operations, fundamentals of PBM pricing, plan design, cost-containment strategies, PBM contracts, PBM procurement, Specialty Pharmacy benefits management, and overall PBM performance with emphasis on cost effectiveness.

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More on this topic:

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Podcast: The Trusted Pharmacist: Advoca