Frequently Asked Questions
Can I join HLA's lawsuit against Optum Rx for PBM audit termination?
Unfortunately, PBM provider manuals contain provisions that prohibit "class actions," meaning the joining of multiple plaintiffs against a defendant in one complaint.
Am I able to file a lawsuit against Optum Rx for PBM audit violations?
Yes, you are entitled to file a lawsuit in federal or state court to hold the PBM accountable for PBM audit violations. Ultimately, however, lawsuits should be a remedy of last resort if PBM audit negotiations fail.
What are the costs associated with filing a PBM audit lawsuit?
Legal fees and expenses vary depending on the nature of the lawsuit and claims involved. Some PBM audit lawsuits may be resolved quickly, whereas others may take longer or be referred to arbitration. Finally, certain claims may be eligible for "contingent fee" arrangements, particularly if you are a specialty pharmacy with high DIR claw-backs.
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