Case Study: National Union Founds Pharmacy in a Pet Shop Problem: A union group recently took over all PBM responsibilities from one of the three large PBMs. Despite numerous complaints about a specific pharmacy by members for being “suspicious” and “unclean,” the PBM stated that the pharmacy had been investigated and was in good standing in the PBM network. Once the union took over management, PIC was asked to run a COPs analysis of the network. Solution: The COPs system identified numerous suspicious clusters of one-on-one or a majority of claims that were one-on-one relationships of pharmacies and physicians which had been passed over for fraud, waste and abuse (FWA) investigations by the PBM. One pharmacy, which appeared to be highly utilized by members (and for that

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