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PBM Appeals Tool

 

 

 

 

 

 

Stop Getting Paid Below Your Cost. Finally Execute PBM Appeals the Right Way.

PBM appeal laws exist - but most pharmacies don't have the workflow, documentation, or time to execute them. 

The PBM Appeals Tool inside Pharmacy Marketplace helps you organize, submit, and track appeals with verified invoice proof—so you can protect your margins and reclaim lost revenue.

See How the Appeals Workflow Works

PBM Underpayments Aren’t Just Frustrating. They’re Systemic.

Independent pharmacies face PBM underpayments every day—but most appeals fail because:

  • Appeals laws are confusing and vary by state

  • Invoices are hard to find, incomplete, or rejected

  • Deadlines are missed due to manual tracking

  • There’s no organized workflow to manage volume at scale

The result: pharmacies either eat the loss or give up entirely.

Legislator PBM Oversight Email Download

Request for PBM Oversight and Enforcement Based on Multi-State Findings

The “Request for PBM Oversight and Enforcement Based on Multi-State Findings” email is available for Pharmacies Stakeholders to download and share with your legislator or your commissioner. It outlines key concerns identified across multiple states and urges stronger oversight, enforcement of existing regulations, and greater transparency from pharmacy benefit managers (PBMs) to protect pharmacies and ensure patient access to care.

Email template
State Map

PBM Appeals Law by State

Where is your state in the process of PBM Appeals. Reference our map for the most accurate information. 

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A purpose-built PBM Appeals Workflow

- Inside Your Purchasing Platform

The PBM Appeals Tool was built to close the execution gap between PBM appeal laws and real-world pharmacy operations.

Instead of spreadsheets, inbox searches, and guesswork, Pharmacy Marketplace provides a structured system to:

  • Organize appeal workflows

  • Attach verified invoice proof tied to catalog index

  • Track deadlines, responses, and outcomes

  • Improve consistency and success rates

This is margin protection—operationalized.

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The PBM Appeals Process

PBM Appeals Background Video

Watch our short video detailing how Pharmacy Marketplace developed our PBM Appeals Tool with our Lead Trainer, Kayla Copeland, CPhT, to help pharmacies stop losing money on underwater claims. 

Who It's For

Built for Independent Pharmacies That Refuse to Accept Losses

Ideal for:

  • Independent community pharmacies

  • Pharmacies struggling with MAC and PBM underpayments

  • Teams with limited staff time for manual appeals

  • Owners who want visibility into margin leakage

See it in Action. 

Proof/Credibility

Designed From Real Pharmacy Pain Points

Developed alongside independent pharmacies, the PBM Appeals Tool reflects real operational challenges—not theoretical compliance.

"Finally, a platform that brings real dollars in real time. The dollars that we shouldn't have to work for at all. You know the ones the underwater dollars.

No more turning patients away. No more incomplete patient profiles. Continuity of care matters!! Pharmacy Marketplace delivers!"

- PHD Pharmacy, Cleveland, TN

Take Back Control for Your Gross Profit

PBM appeal laws only work if you can execute them.
See how the PBM Appeals Tool helps pharmacies turn underpayments into recoverable revenue.