The Facts
- Industry: Technology and Engineering
- Pharmacy Claims Reviewed: 1.6M+
- Variances Recovered: $2.5M
- Solutions: truGuard
The Problem
A global tech & engineering company wanted to increase visibility into their pharmacy plan performance and ensure that the program was performing per the negotiated contract terms with their PBM.
To increase transparency into their pharmacy contract, the client chose to partner with Truveris to conduct 100% claims monitoring and oversight, leveraging truGuard technology.
The Approach
Truveris technology (truGuard) readjudicates 100% of pharmacy claims to ensure each one is adhering to the pharmacy contract. truGuard provides early detection of contract programming errors, so clients can reconcile errors or variances as they occur.
Shortly after initiating truGuard, Truveris flagged a large discrepancy in the client’s pharmacy claims. Initially, the client’s PBM reported a shortfall of $625k, whereas Truveris’ technology flagged a shortfall of $1.9M.
Confident with their reporting, the PBM asked the client to invoke an official audit to review the discrepancy. The formal audit revealed mislabeling by the PBM, resulting in a pay out over $1.9M to the client detected by truGuard.
The next year, the PBM reported a surplus of $225K, while Truveris reported a short fall of ~$610K after analyzing the client’s pharmacy claims. This time, Truveris worked closely with the PBM to have them review their reports internally to ensure accuracy in reporting.
The PBM found and corrected the confirmed errors in their reporting, resulting in a reported short fall of ~$609K, which went back to the client.
The Results
Ultimately, by leveraging Truveris’ claims monitoring technology, truGuard, the client recovered more than $2.5M in contract discrepancies in two years. The client was fully reimbursed by the PBM for both discrepancies.
Truveris is a pharmacy cost containment company dedicated to reducing pharmacy costs and driving transparency for employers and benefit consultants. Our proprietary, data-driven technology and deep industry expertise empower smarter pharmacy benefit decisions through contract optimization and PBM oversight. Independent and unbiased, Truveris delivers measurable savings and accountability across every pharmacy program.
