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PBM Rebate Audits: Tips for Health Plan Success

Presenters: Derek Frye, Audit and Compliance Practice Leader; Terri Poindexter, Strategic Consultant, Health Plan Market


Prescription rebate dollars available from manufacturers and PBMs have grown significantly in recent years. In fact, rebates now account for more than 20% of all PBM-provided savings on prescription drugs. But many health plans are unaware of the steps and audit documentation they are responsible for tracking now to avoid leaving money on the table in a future audit. Meanwhile, regulatory developments make it more important than ever for health plans to make sure their PBMs are capturing rebate data correctly.

In this webinar, we will discuss several critical ways health plans can benefit from conducting a PBM rebate audit – and more. You will learn:

  • What’s driving today’s higher rebates, and what to do to make sure you get your fair share.

  • Why PBM rebate audits are more important than ever from both a monetary and compliance standpoint.

  • What to expect as part of the PBM rebate audit process.

  • What documentation health plans are responsible for to ensure a successful PBM rebate audit.

  • How to review your current PBM contract to ensure there are no barriers to conducting a rebate audit.

  • How PBM rebate audits can reduce Medicare Advantage plan CMS compliance risks related to DIR data submissions.

  • How PBM rebate audits support compliance with state requirements related to 340B-eligible claims.

Presenters: Derek Frye, Audit and Compliance Practice Leader; Terri Poindexter, Strategic Consultant, Health Plan Market

The webinar recording can be accessed here.
 
The webinar slides can be accessed here.

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