PBM Credentialing Insurance Requirements
What this clause says
Pharmacy shall maintain Druggist Professional Liability coverage of not less than $1,000,000 per claim and Commercial General Liability of not less than $1,000,000 per occurrence, with Certificate of Insurance on file with PBM, naming PBM as Certificate Holder, and providing thirty (30) days prior written notice of cancellation, non-renewal, or material modification.
What this means in plain English
PBM network agreements (Express Scripts, CVS Caremark, OptumRx) require druggist professional liability and general liability minimums plus current COI on file. Lapses cause silent network removal — the pharmacy keeps dispensing while claims get denied.
What it means for a CDMO program
Specialty pharmacies live and die by PBM network status. A 30-day notice of cancellation lapse on the COI can trigger termination from a limited-distribution drug network, which is often the entire revenue line. Reinstatement after administrative lapse is sometimes possible; reinstatement after claims-driven termination is harder.
How this evaluates
The Decoder applies these rules in order; the first match wins.
- pbm network › coi current is set → Compliant: PBM COI on file and current.
- pbm network › coi current is not set → Gap: PBM COI status unverified — critical for limited-distribution credentialing.
See this in your MSA
Pre-loaded with this clause selected.
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