Pharmacy Benefit Management Audit: Keeping Things Efficient and Cost-Effective

PharmacyEffective audits, innovative plan designs, and better focus on controlling member behavior aspects can go a long way in reducing the cost trends in the pharmacy planning. A pharmacy benefit manager (PBM) helps health plan sponsors work out a pharmacy benefit management program, following an audit of the system. explains that a pharmacy benefit management audit covers various aspects, including clinical programs, plan design applications, providing access to mail-orders, and formulatory development, etc.

Effective auditing not only ensures that plan members and sponsors are offered market rates, but it also ensures that excess PBM profits are eliminated.

Pharmacy Claim Analytics, or PCA, is a sector now gaining a lot of momentum and attention in the world of healthcare. PCA companies develop advanced software that can help monitor the PBM’s adherence to the contract terms, by offering real-time analyses of claims. A PCA solution can reduce costs by as much as 5-30%, and is a useful tool for pharmacies, considering the rising costs involved in healthcare these days.

What does a PCA do? Typically, they do the following:

  • Offers real-time claim data analyses to verify invoice expenses, as well as to prevent overcharging.
  • Analyses all the available data on PBM pharmacy claims with invoices.
  • Offers prospective claims analyses
  • Offers tools with features such as reporting, compliance and secure archive.
  • Offers a web-based ASP (Application Service Provider)

PBMs bill never have i ever questions funny more than 10 billion prescription claims in a span of two weeks. To review the accuracy of the bills sent out is next to impossible, but with PCA, this is not only possible, but easy as well. PCA solutions also include tools to enforce the PBM contract, verify accuracy of invoices as well as ensure accountability.

If you are looking to make your PBM more effective, a pharmacy benefit management audit is the first step you should take. Consider investing in a PCA solution as well, to ensure that things run smoothly and efficiently.