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.
Review of claims to verify that benefits have been appropriately applied for the benefit designs and formularies offered under the plan.
Review of drug use patterns, claims and clinical management, including drug quantity limits, therapy duration limits, prior authorizations and step therapy protocols.
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.
Determines with reason able assurance that the rebates paid to the client are compliant with manufacturer agreements.