Tuesday, April 7, 2015

Why Audit Your Pharmacy Benefit Plan?

Intelligent Solutions in Pharmacy Benefits
612 Wheelers Farms Road, Milford, CT 06461
(888) 797-2479

PBIRx, Pharmacy Benefit Plan, Pharmacy Benefit Auditing
If you are spending millions of dollars on your pharmacy benefit WHY wouldn't you audit your claims for accuracy to the pharmacy contract discounts and guarantees? Do you think that all "manual" input of data into the PBM system is done without any errors? If so, you are very wrong.
Unfortunately, plans choose to audit when there is a slight problem and realize that they have lost the opportunity to audit claims for many years because of PBM contract language, which only allows an audit of the previous 12 to 18 months. At PBIRx, clients are educated and audit their PBM claims every year as they look forward to that recovery check. One of our clients was just sent a check for over $200,000.

As we have stated so many times before, pharmacy spend is at an all time high with a very robust pipeline of expensive new drugs - some cost over $500,000 per year. Many entities fall victim to claims that are either not outlined or are adjudicated at lower discounts because of creative language in the contract with their PBM, and therefore, lose out on heaps of savings and/or recoveries. Another problem is when the PBM does not appropriately manage your eligibility and you are paying claims for terminated members.

But there has to be a way to avoid paying out of pocket for wrongly inherited costs, right? The good news is, the answer to that question is yes! Here at PBIRx, using our proprietary AuditRx technology we have been very successful in auditing pharmacy benefit plans with significant plan recoveries. As part of our auditing service, we also perform 340B compliance audits for many hospitals nationwide to make sure that the pharmacy is HRSA compliant and is aware of optimizing revenues.

For more information about our auditing services, please visit us at or contact us at (888) 797-2479 today.


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