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The Health Plan's Guide to Auditing PBM Contracts: Update for the 2019-2020 CMS Audit Season

29 Pages

We are pleased to offer an updated and revised edition of this guidebook. Since its original publication in 2017, many of the chapters are even more relevant for today due to a number of industry developments.

The only way to know for certain is to audit your PBM on a regular basis. This guide provides expert insights into why auditing your PBM is so critical in today’s market. It discusses the types of PBM audits available and provides practical advice on scheduling and prioritizing PBM audits for maximum impact. With this guide in hand, you will maximize your drug cost savings, reduce compliance risks, and improve member service levels.


  • Why auditing your PBM is important …and how it can save money and reduce compliance risks
  • Common mistakes PBMs make when calculating rebates… and how to get your fair share of dollars
  • Why doing audits gives you greater negotiating leverage with your PBM
  • Best practices for prioritizing and scheduling PBM audits

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