Audit & Oversight

Our Insights Optimize Drug Spend

Our PBM auditing expertise provides plan sponsors with extensive pharmacy program monitoring, assurance of accurate program implementation, and comprehensive analysis of PBM contract adherence.
Full-scope and a la carte audit options are available to give you the flexibility to choose the appropriate bundle of audit services that meet your unique needs.

%

of audits resulted in client recoveries

audits conducted over the past two years

%

of pricing audits show the PBM to be underperforming against contract guarantees

DOWNLOAD OUR PBM AUDITS WHITE PAPER

GET IT HERE |

Benefit Plan Design Audit

Review of claims to verify that benefits have been appropriately applied for the benefit designs and formularies offered under the plan.

CLINICAL AUDIT

Review of drug use patterns, claims and clinical management, including drug quantity limits, therapy duration limits, prior authorizations and step therapy protocols.

PRICING GUARANTEE AUDIT

Review of claims to verify that the pricing protocols and financial guarantees applied by the PBM are compliant with the terms of the contract.

"We were able to realize 10:1 ROI on the targeted audits and reviews that PSG performed on our behalf."

- Shawn Barger (AvMed) in presenting with PSG at the 2017 PBMI Drug Benefit Conference

Implementation Audits

Pre-implementation audits and pricing implementation reviews ensure that plan design parameters are accurate and designed to accomplish the objectives set forth by the plan sponsor.

Rebate Audit

Determines with reason able assurance that the rebates paid to the client are compliant with manufacturer agreements.

Fraud, Waste & Abuse Audit

Provides ongoing monitoring, identifies outliers and trends, validates appropriateness of drug usage, and provides follow-up analysis.

DOWNLOAD OUR AUDITS OVERVIEW SELL SHEET

DOWNLOAD |

Audits Leadership Team

Joshua Rogers

Chief Compliance Officer

Beth Zander

Director, Audit Services