Clinical and Utilization Management Edit Audits
Clinical and UM edit audits verify that your PBM is accurately executing the clinical controls you have in place, giving you confidence in their performance.
Audits
Solutions
Audits
Our PBM auditing expertise offers extensive pharmacy program monitoring, assurance of accurate program implementation, and a 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.
Custom audits are targeted audits designed for client-specific needs, built around your organization’s priorities, PBM contract structure, and areas of greatest risk or opportunity.
Financial and pricing audits help ensure that contractual terms and financial guarantees are being met, giving you the evidence you need to make confident decisions.
Plan design audits verify that your PBM is accurately translating your benefit intent into day-to-day operations and that it is performing exactly as you designed it.
Pre- and Post-Implementation Audits
Implementation audits ensure that none of your pharmacy program dollars are being wasted and that plan design parameters are accurate.
Rebate audits help ensure accuracy and completeness across drug manufacturer rebates and associated fees, spanning both pharmacy and medical drug benefits.
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