Caremark Cease and Desist Letters – Trudhesa®

PAAS National^® analysts have recently assisted a few pharmacies that received “Cease and Desist” Letters from Caremark related to dispensing Trudhesa^®nasal spray for migraines. The strongly worded letters alleged that pharmacies were in violation of the Provider Agreement and various sections of the Provider Manual.

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Caremark alleged that pharmacies had allowed a “pharmaceutical hub” to use the pharmacy’s identity or billing information to submit claims and outsourced the collection of patient copays. Additionally, Caremark demanded that pharmacies immediately cease these violating actions and reverse all offending prescription claims.

Purportedly, all prescriptions for Trudhesa^® were received as transfers from a hub pharmacy such as Phil, Carepoint Pharmacy, or ASPN pharmacies which appear to be “digital pharmacies” and the only way that Trudhesa^® is available per the manufacturer website.

Pharmacies that are not responsive to Caremark’s demands may face network termination.

PAAS Tips:

Be very cautious when receiving transfer prescriptions from hub pharmacies
Review Caremark Provider Manual section 4.12 to learn about acceptable practices related to pharmaceutical hubs

Author
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Eric Hartkopf, PharmD

Analyst at PAAS National^®

As an Analyst, I focus on providing pre- and post-audit assistance, answering various member service questions, and researching & drafting articles for the Third-Party Newsline. I work with many of our members involved with invoice audits.

I obtained my PharmD from the University of Wisconsin-Madison School of Pharmacy and worked for a major chain as well as various LTC and independent pharmacies, before coming to PAAS.

I am passionate about learning and teaching. I strive to learn something new about PBM audits every day, so that PAAS can be more knowledgeable to better serve our members! In 2018, I started traveling to state pharmacy conferences to present audit seminars and meet our wonderful members in person.

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