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PBM 101: What is a PBM audit and should I have one done?

A Pharmacy Benefits Management audit is a process where a review of the PBM performance (contractually and/or financially) is performed for a client.

An audit needs to be performed by someone who is knowledgeable bout the PBM industry. There are many subtle differences from a traditional financial or banking type audit.

Large accounting firms may not have the expertise on staff to know where to look for discrepancies. They may not have the experience to perform this type of audit.

PBM audits typically come in two versions:


  • Version One: In essence it is a pricing audit.
  • Version Two: Is more comprehensive in scope and looks at the pharmacy benefit from a more strategic perspective.


Hiring Crystal Clear Rx to conduct a pharmacy audit service allows the organization the right tools to help you increase the value while you decrease your costs. Our audits review key areas that many overlook. It allows us to identify solutions that will:

  • Improve negotiations for a better program with your current PBM.
  • Streamline and manage a process to help you choose a new PBM.
  • Determine how your pharmacy benefits program is performing.
  • Give you the right information for you to decide to implement benefit design changes.



 


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