Last month, Health Law Alliance achieved full reversal of a PBM credentialing denial for a New York pharmacy—mere weeks after it received a termination notice. Read more to learn how Health Law Alliance’s tireless advocacy can help your pharmacy in credentialing disputes.
At Health Law Alliance, our attorneys are the best of the best when it comes to winning battles with PBMs. Last month, our team helped a New York pharmacy win full reversal of a credentialing denial from CVS Caremark (Caremark), one of the nation’s largest PBMs. The reversal is the latest win for our PBM audit practice group, a team of attorneys with unrivaled expertise in helping independent pharmacies fight back against PBMs and ensure their businesses continue to thrive.
In late 2025, Caremark contacted an independent New York pharmacy, requesting additional information to support its re-enrollment application. But just one month later, Caremark’s credentialing committee didn’t just deny the pharmacy’s application: it terminated the pharmacy from its network entirely, citing the pharmacy’s alleged affiliation with an unrelated “problematic” pharmacy based on a pharmacist’s employment history. The pharmacy immediately contacted Health Law Alliance’s PBM defense team to challenge the decision and help restore the pharmacy’s network status.
Back in the Game: How HLA Helped an Independent Pharmacy to Remain in Network
As PBM appeal experts, our attorneys know that thorough documentation is key to successfully rebut unfair credentialing determinations. In preparing the pharmacy’s appeal, our team established the pharmacy’s documentary record, demonstrating that the pharmacist in question was no longer employed. The response carefully articulated Caremark’s good faith and fair dealing obligations, outlining the numerous reasons why Caremark was required to afford due consideration to the pharmacy’s documentation.
Affiliation-based terminations are a growing risk area for independent pharmacy owners. PBMs are increasingly terminating pharmacies based on tenuous connections, citing alleged links between pharmacies and individuals or entities it deems “problematic”—including minor ownership interests, relationships with prior employees, and even connections between family members. In these cases, thorough documentation can make the difference between remaining in-network and termination.
Last month, Caremark notified the pharmacy that it would be conditionally reinstated as a participating provider in Caremark’s network. With HLA’s help, the pharmacy can continue providing vital care to New York patients, protecting the pharmacy from reputational harm and financial disaster.
HLA: PBM Experts Ready to Fight for You
As an independent pharmacy owner, the deck is stacked against you from the start. PBMs use vague allegations and sneaky procedural tactics to prevent your pharmacy from succeeding. Every day, PBMs are finding new ways to claw back thousands in unjustified recoupments from pharmacies. Fighting back against these industry giants can feel like an impossible task. But at Health Law Alliance, we take on PBMs every day, working tirelessly to arm pharmacies with the ammunition they need to defend against unfair tactics designed to harm your business.
Has your credentialing application been denied? Need help pushing back against erroneous audit findings? Contact us today—we’ll take it from here.
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