Auditing Services

Ensuring that a pharmacy benefits plan is performing as expected is a fiduciary duty—not just an optional activity. When the time comes to verify the accuracy of claim payments according to the contractual agreements, turn to Health Strategy for an objective, comprehensive, and accurate review.

Three Types of Formal Audits

All Health Strategy audits are designed to ensure that clients are receiving the full value intended in their pharmacy benefit contract. From validating pricing and discounts to ensuring that rebate dollars are distributed, we make sure your contract is implemented appropriately. We also conduct audits on behalf of clients even if we didn’t negotiate their contract.

Audit Type Description Areas of Review
Audit Type
Pricing Performance
Description
Focuses on validating contractual pricing obligations with actual pharmacy claims data
Areas of Review
  • Aggregate discount guarantees
  • Dispensing fee guarantees
  • Drug level pricing guarantees
  • Transactional administrative fee guarantees
  • Rebate guarantees
Audit Type
On-site Manufacturer Revenue
Description
Focuses on the manufacturer revenue portion of a contract and the confidential agreements between pharmaceutical companies and PBMs
Areas of Review
  • Invoicing (errors or duplicates)
  • Collection of rebate dollars invoiced by PBM
  • Distribution of rebate dollars
Audit Type
Benefit Design
Description
A summary of a client’s pharmacy benefit
Areas of Review
  • Proper copay amounts
  • Deductibles and out-of-pocket maximums
  • Formulary tiering
  • Coinsurance percentages
  • Excluded products

Explore your options.

Reach out to Health Strategy to explore whether or not an audit would benefit your pharmacy benefit plan. We’ll walk you through the timing, cost, process, and confidentiality considerations.

Contact Us

“We engaged Health Strategy to help guide our pharmacy strategy in 2010 and have been working with them ever since. The return on investment every year has been greater than 15:1.

Health Strategy is engaged on every one of our PBM and pharmacy related calls to ensure they are up to speed on all facets of our pharmacy benefit. They weigh in and provide recommendations on all pharmacy strategy decisions. Working closely with us, they created our plan design, created a custom formulary and provide ongoing management of it. These items have allowed us to enjoy a world class 89% generic dispensing rate with significant annual savings.”

–Benjamin Ryder, Sr. Benefits Manager, Whirlpool Corporation