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Auditing

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PBM auditing is widely done by managed care organizations, insurance companies, self-funded employers, drug manufacturers and state and local governments. Different types of audits are conducted to verify:

  • Guaranteed Discount
  • Benefit Design and Clinical Programs
  • Annual Financial Guarantees
  • Performance Guarantees
  • Rebates
  • Eligibility
  • Administrative Fee

Different types of audits are conducted to verify the correct billing of contracted network rates, rebates, administrative fees and performance guarantees.

It is advisable for a Plan Sponsor to annually validate their PBM's contract terms, performance guarantees and pricing guarantees.