Pharmacy benefits are more complex than ever. The shifting nature of pharmacy terms, pricing, and policy updates create the potential for discrepancies between expected outcomes and PBM-reported performance.
truAudit provides a formal means to deeply investigate a set of claims for accurate contract fulfillment and programming, with cooperation from the PBM.
Ensuring Fiduciary Responsibility through Pharmacy Audit and Performance Checks
When a potential claims discrepancy is identified, following through with a formal audit demonstrates active due diligence efforts and fulfillment of fiduciary responsibilities.
A formal audit brings the PBM into the process and allows for an independent, third-party review of contract term programming and implementation.
Support for Audits Across Your Benefit Plan
✓ Implementation Audits assess PBM benefit setup and rules accuracy before or after contract go-live.
✓ Rebate Audits review rebate invoicing, methodology, and payments against contract guarantees.
✓ Clinical Audits validate clinical coverage and exclusion rules, prior authorizations, quantity limits, and step therapy edits.
✓ Benefit Design Audits review member out-of-pocket amounts, accumulators, benefit exclusions, and duplicate claims.
Case Study: How A Pharmacy Benefits Audit Revealed Contract Errors and Incorrect PBM-Reported Shortfalls
Through ongoing PBM claims oversight, a global technology and engineering company noticed spend discrepancies in their PBM reports.
Truveris helped the client confirm the financial discrepancies and advocated on their behalf throughout the independent audit and reconciliation process.
Request info about pharmacy benefit audits
Connect with our team to understand how an audit can support oversight for your pharmacy plan and what to expect.