20 - PBM Audits – Being Prepared is the Key to Success
Wednesday, April 8, 2020
5:00 PM – 6:30 PM
Location: Colorado B-D
PBMs and pharmacies need one another. However, PBMs control whether or not a pharmacy gets paid, which means PBMs definitely have the upper hand. One way a PBM exercises control over a pharmacy’s payments is by conducting audits. In conducting an audit, if a PBM concludes that it should not have paid a claim, then it will recoup the money, usually in the form of offsets. This round table will discuss activities that PBM’s consider suspect which might trigger an audit. In addition, the discussion will address what steps a pharmacy can take to reduce the risk of a PBM audit and, in the event an audit is instigated, how to respond favorably, thereby reducing the negative results.
Understand those pharmacy activities that PBMs consider to be suspect.
Describe steps that can be taken to reduce the likelihood of an audit.
Outline steps to take if the pharmacy is subjected to a PBM audit.