PBM Audits of Pharmacy Transactions: Removing the Ambiguity between Health Plan and PBM

By Derek Frye
Tue, Jun, 11, 2019

Average Wholesale Prices (AWPs), Maximum Allowable Charges (MACs), generics versus brands, dispensing and administrative fees: the terms form an alphabet soup of acronyms against which various percentage discount formulas are then applied in your PBM contract. Then the formulas are applied against literally millions of individual pharmacy transactions.

Latest

HCCA Managed Care 2019: CMS Regulation and Program Updates

Yvonne Zachman Fiedler
Wed, Apr, 10, 2019

It’s time to start thinking about CMS audits

Yvonne Zachman Fiedler
Tue, Dec, 18, 2018

Improving Drug Utilization Review Controls

Jason Hoyme
Tue, Nov, 21, 2017

PBM Audit Best Practices: Tips for Prioritizing and Conducting PBM Audits

Yvonne Zachman Fiedler & Derek Frye
Thu, Jun, 29, 2017

Pharmacy Audits: Removing the Ambiguity Between Health Plan and PBM

Margaret Berlack & Derek Frye
Thu, May, 25, 2017

Receive full value from your PBM rebates

Chris Hanson-Ehlinger
Thu, Nov, 20, 2014

Align data validation stakeholders to avoid last minute mistakes

Chris Hanson-Ehlinger
Mon, Aug, 18, 2014

Are your PBM pricing discounts seriously underperforming?

Chris Hanson-Ehlinger
Mon, Apr, 07, 2014
Free Guide

The Health Plan's Guide to Auditing your Pharmacy Benefit Manager Contract from A to Z

Download Now
Privacy Policy