Comprehensive PBM contract audit services.

Full Claims Audit

A comprehensive review of 100% — or a statistically significant sample — of your pharmacy claims.

What we examine

• Verification of AWP discounts, MAC pricing, dispensing fees, and ingredient costs

• Identification of overpayments, underpayments, and adjudication errors

• Side-by-side comparison of contracted rates versus actual billed rates

Rebate & Revenue Audit

Manufacturer rebate validation and comprehensive revenue stream reconciliation.

What we examine

• Manufacturer rebate pass-through verification against your contract guarantees

• Performance guarantee compliance — minimum rebate guarantees, price protection

• Reconciliation of DIR fees, administrative fees, and other revenue streams

Contract Compliance Review

Detailed analysis of your PBM master services agreement against actual PBM performance.

What we examine

• Gap analysis between contract terms and real-world PBM behavior

• Pre- and post-implementation audits for new or renegotiated PBM contracts

• Identification of contract language gaps that expose you to financial risk

Specialty & Operational Audits

Deep-dive audits covering specialty pharmacy, clinical programs, and Medicare-specific requirements.

What we examine

• Specialty pharmacy pricing and utilization review

• Formulary management and clinical program effectiveness analysis

• PDE (Prescription Drug Event) data validation for Medicare Part D

• EGWP and RDS audit support

Ongoing Monitoring & RFP Support

Long-term partnership to ensure continued PBM accountability and support through vendor transitions.

What we examine

• Annual or quarterly audit programs to catch issues before they compound

• Assistance with PBM Request for Proposals (RFPs) and vendor selection

• Contract negotiation support and language recommendations