Pharmacy Claims Audits

Our Pharmacy Claims Audit platform was built to assess the accuracy of prescription drug claims payments in the same precise and comprehensive manner as our Medical Claims Audits. Pharmacy Claims Audits focus on assessing the Pharmacy Benefit Manager’s (PBM) compliance with the plan parameters outlined in the Client’s Summary Plan Description and the Administrative Services Agreement. Pharmacy Claims Audits help organizations identify claims processing errors, recover overpayments and obtain objective criteria needed to evaluate the competitiveness of the PBM contract terms.

When our Pharmacy Claims Audits are completed, our Clients are able to objectively assess the performance of their PBM. They also have a much better understanding of the cost drivers of their pharmacy benefit plan and how to improve the performance of the pharmacy benefit in the future.