The hidden cost of unaudited PBM contracts.
PBMs manage billions in drug spend, but complexities in pricing, rebates, and performance guarantees often result in significant financial leakage that goes undetected — until an independent audit surfaces it.
Five reasons every plan should audit
Ensure fiduciary responsibility
Plan sponsors have a legal and ethical obligation to act in the best interest of plan members. An independent PBM audit is one of the clearest ways to demonstrate that obligation is being met.
Recover overcharges and enforce guarantees
PBM contracts contain pricing guarantees that are frequently not honored. An audit identifies the gap between what was promised and what was paid — and creates the documentation needed to recover funds.
Combat spread pricing and opaque practices
Many PBMs profit from the spread between what they pay pharmacies and what they charge plans. Without an independent audit, this spread is invisible. We make it visible.
Stay ahead of regulatory scrutiny
PBM transparency legislation is accelerating at the state and federal level. Plans that audit proactively are better positioned to demonstrate compliance and avoid regulatory exposure.
Achieve better outcomes in future negotiations
Audit findings create leverage. When you know exactly where a PBM underperformed, you have concrete data to demand better contract terms at renewal — not just assertions.
Results from the field
Anonymized examples from real client engagements.
Client A
$2.8M recovered
Recovered in one audit.
[PLACEHOLDER — confirm these stats are approved for public use]
Client B
12% savings opportunity identified
Identified through contract renegotiation.
[PLACEHOLDER — confirm these stats are approved for public use]
Find out what's in your PBM contract.
A free consultation will identify the highest-risk areas in your specific PBM arrangement before we commit to a full engagement.
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