- Provides assurance that your prescription drug program is in contractual compliance with guarantees & financial statements
- Identifies discrepancies in Rx claims adjudication & rebates as compared to PBM agreement language
- Allows opportunity for significant Rx monetary recovery as result of your AuditRx team negotiation with PBM
- Presents accurate information to renegotiate improved financial terms with PBM
AuditRx is PBIRx’s proprietary prescription benefit audit program
AuditRx, state of the art audit technology, along with our experienced auditors, have uncovered discrepancies and delivered financial recoveries to hundreds of PBIRx clients since 2001. Are you working with an experienced independent third party auditor or is your PBM performing its own audit?
Why should you audit? PBMs are not fiduciaries. AuditRx is needed because of clients’ concerns with not only scrutiny in the PBM industry, but also PBM lawsuits; and the inherent discrepancies within a pharmacy benefit manager resulting from human error, contract language, proposal language, mergers, acquisitions, systems conversions, systems enhancements, etc. as to how the pharmacy claims are actually being adjudicated and invoiced.
With high cost specialty claims representing over 50% of drug spend, it is the plan’s responsibility to ensure the accuracy of Rx claim processing, rebate remittance, plan design parameters, and eligibility, as compared to the PBM agreement’s guarantees and other verbiage. AuditRx is the solution.