PBM Pharmacy Audits
PBM Pharmacy Audits
Benefit Audit Services
We estimate that over 60% of clients are owed money by their PBM, which means you could be leaving money on the table.
There is no reason why an employer group should pay more for their claims because of their benefits not being configured correctly. That is why AlignRx has developed a program which reviews your utilization to ensure all claims process according to your benefit design.
Our industry-leading program details performance against your contract terms allowing for comprehensive monitoring of your benefit design along with providing a detailed analysis of claims performance against the summary plan design and financial provisions of your contract.
Our benefit audits closely examine the following areas to identify money left on the table:
- Clinical Edit Review
- ACA Requirement and Accumulators
- Contract Exclusions
- Member Cost Share
PBM Guarantees Financial Audit
We estimate that over 75% of employer groups are owed money from their PBMs due to underperformance of their guarantees, but do not perform an audit to recoup the money owed.
It is not uncommon for PBMs to fall short on their financial guarantees. By performing annual financial audits, AlignRx ensures that our clients are receiving the full value of their contract from their PBM. Our extensive experience with creating and negotiating PBM contracts allows us to identify all areas of exposure and enables us to extract as much value out of the contract as possible.
Our financial audits closely examine the following areas to identify money left on the table:
- Rebate Guarantees
- Discount & Dispensing Fees
- Offset Language
- Contract Exclusions
Our approach is seamless, handling everything from start to finish. The only thing that our clients need to do is cash the check.
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