Is your Pharmacy Benefit Manager [PBM] acting in your best interests - or theirs?

PBMs often hide their major sources of profit:

• Charging health plan  sponsors more than  they pay  the pharmacy;
• Retaining over half the  rebate money from drug manufacturers;
• Overcharging for generics from their ‘captive’ mail order pharmacies.

PBM Contracts - unless  renegotiated - are generally one-sided.

Benefits are often designed to maximize PBM profits at the expense of health plans and recipients.

• Inspect what you expect;
• PBMs are often sloppy - or worse - in performing in  accord with contracted terms;
• Recoveries can be  substantial
• Pharmacy claim-by-claim  audits are feasible since the data is in an industry-standard format.

Our PBM audits are almost always ‘productive’- recovering important dollars for our clients.

Fixed fee evaluation &  overview

Claim by claim audits to validate:

            — Pricing accuracy

            — Eligibility of recipients

            — Adherence to benefit  design

            — Full and timely rebate  payments

            — Correct days supply  dispensed

            — and more.