What do most PBMs require their network pharmacies to adhere to?

Most pharmacy benefit managers (PBMs) require their network pharmacies to adhere to the policies and procedures set forth by the PBM. This requirement is essential for maintaining consistency and compliance throughout their network, ensuring that all participating pharmacies follow the same rules regarding the dispensing of medications, patient care practices, and reimbursement processes. These policies often include guidelines on how to handle medication dispensing, patient confidentiality, claims processing, and formulary management.

Adhering to these policies is crucial for pharmacies to remain in good standing with the PBM, enabling them to provide services efficiently and receive timely reimbursements. Additionally, it helps to ensure that the services offered are in alignment with the overall objectives and standards of the PBM, ultimately benefiting the patients who rely on their medications.

While adherence to state and federal marketing regulations, consumer protection laws, and individual store promotions are important aspects of pharmacy operation, they do not specifically reflect the overarching operational structure and collaboration that PBMs require from their network pharmacies. Focused compliance with PBM policies ensures that pharmacies can navigate the complex environment of pharmacy benefit management effectively.