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When it comes to auditing the performance of a Pharmacy Benefit Management (PBM) firm, the complexities of business models and the data that drives each transaction requires extensive experience from a consulting firm that is focused on pharmacy benefits. APC is uniquely positioned as a national leader in providing comprehensive PBM audit programs to self-insured corporate clients, managed care organizations (MCO), Medicare Part D and Medicaid plan sponsors, Unions and State/Local government agencies.
Our team of industry experts utilizes First Data Bank and Medi-Span as a resource for validating appropriate pricing, and our proprietary analytical tools have uncovered substantial recoverable cost savings for many of our clients. In fact, recent audit findings have identified cost saving opportunities for clients that calculate to an average Return on Investment of over 700%. Over the past five years, APC has conducted audits on over 20 PBM firms and has been recognized as an approved auditor by every national PBM, including CVS/Caremark and Express Scripts (ESI). Our methodologies are accurate, consistent and always in the best interest of our clients.
APC PBM Audit Services provides a modular approach to creating an audit strategy. You can request a comprehensive audit or you can design a program that can be conducted over a few years. We are flexible and can help provide you with guidance about how to build an audit strategy that works for you. Our audit modules include the following components:
- Retail and Mail Pricing Compliance
- Electronic Claims and Benefit Design Accuracy
- Rebate Administration Accuracy
- Mail Service Operations
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- Retirement Drug Subsidy (RDS) Management
- Medicare PDE Reconciliation Accuracy
- Medicare Coordination of Benefits (COB) Compliance
- Claims Edits, and much more.
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For more information, please contact us or simply Request a Proposal.
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