Guarantee Financial Performance Amidst PBM Contract Changes
When a PBM contract shifted to a single PMPM guarantee, PSG conducted a detailed audit to identify $2 million owed to the client.
The Challenge
A large payer reached out to PSG after their PBM contract shifted from traditional pricing and rebate guarantees to a single PMPM guarantee. With numerous interconnected pricing components, the client needed confidence that all new terms were set up accurately within the PBM’s systems and reporting. Since this pricing model was new for both the PBM and the client, the client also sought assurance that the revised structure would not introduce unanticipated financial risk or negatively affect overall cost performance.
PSG’s Supporting Services
Audits: Our PBM auditing expertise offers extensive pharmacy program monitoring, assurance of accurate program implementation, and a comprehensive analysis of PBM contract adherence.
Learn More
Download the full case study to see how PSG stepped in to help identify money owed to the client through a comprehensive audit!