Health Law Alliance successfully reversed pending terminations for 7 New York pharmacies. Read more about how our PBM audit team achieved this stunning reversal.
At Health Law Alliance, our PBM defense attorneys have garnered an outstanding reputation for winning countless battles against the nation’s largest PBMs. This week, our attorneys successfully defended 7 New York pharmacies from terminations by OptumRx (“Optum”). Because of HLA’s relentless advocacy, these pharmacies will remain in network, preventing disruption in care for thousands of New York patients.
These stunning wins stem from termination notices Optum first issued to the pharmacies in February 2025, citing alleged affiliations with a “problematic” pharmacy Optum had previously terminated. Health Law Alliance represented the pharmacies from day one, meticulously preparing comprehensive appeals to the initial termination notices, communicating with auditors, and helping to compile substantial documentation to rebut Optum’s erroneous findings.
A Proven Strategy: How Our Attorneys Won Full Reversal of Optum’s Terminations
As we’ve highlighted on our blog, affiliation-based terminations are becoming increasingly common in today’s market. In 2026, PBMs are continuing to cite superficial connections between “problematic” pharmacies and a network pharmacy’s owners or staff members to justify termination. In cases like these, having a robust documentary record proving a pharmacy’s ownership and connections with related pharmacies is key to a strong rebuttal.
For these pharmacies, Health Law Alliance crafted a carefully tailored appeal strategy, preparing thorough, comprehensive appeals that outlined each pharmacy’s lack of connection to the “problematic” pharmacy Optum cited. In these appeals, our team emphasized that Optum’s rationale was insufficient to support as drastic a remedy as termination, particularly given that the termination notices failed to cite any specific instances of non-compliance with Optum’s Provider Manual or improperly submitted claims. When Optum doubled down, our attorneys pushed back harder, demanding that Optum provide additional dispute resolution meetings to ensure the pharmacies’ evidence was fully considered.
On April 2, Optum notified each of the pharmacies that it would immediately rescind the termination notices, allowing the pharmacies to remain in Optum’s networks. This outcome is just one example of how HLA can help your pharmacy fight back against unjust audit findings and preserve your reputation.
PBMs Are No Match for Health Law Alliance
Independent pharmacy owners are struggling to stay afloat in an era of aggressive PBM enforcement. In 2026, PBMs continue to devise new ways to remove pharmacies from their networks as state-level PBM reform lags. Without seasoned counsel, fighting back against a network termination notice is next to impossible. Our attorneys have a proven track record of success in fighting against erroneous audit findings and outcomes and can help you navigate every step of the appeal process.
If your pharmacy has been issued a termination notice, don’t wait. Contact us today and let us help you win the fight.
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