Solutions to Critical Requirements
Drug Spend Review
(Pharmacy Audit, Pharmacy Review, PBM Audit, PBM Review, Drug Spend
Audit)
Why conduct a review?
If you are wondering if your PBM is processing your claims according to your
instructions, or wondering how the many news releases of PBM lawsuits could
affect your situation, you are not alone. The answer is to allow MCAG to perform
a claim by claim retrospective audit of your PBM. It is standard in the industry
and provided for in your PBM Services Agreement.
The result of the audit exposes all facets of the processing of your claims,
may result in a restitution payment, and will increase your understanding of
your pharmacy expense.
Audit Gives Knowledge: A major result of a
pharmacy audit is the increased knowledge you and your team will gain from the
process. With direct reporting of audit discrepancies and PBM processing
procedures, our clients relate that they have a much better understanding of the
PBM industry after the audit. With better knowledge you can build a better
pharmacy benefit and better understand the pharmacy contract.