Best Practices for Including Audit Terms in Your PBM Contract
By Steve Baumgardner & Derek FryeTue, Dec, 17, 2019
Conducting regular audits of your PBM is one of the best strategies health plans can use to make sure the PBM is fully delivering on its contractual terms. In order to successfully implement an audit strategy, audit rights have to be negotiated with the PBM, and it’s not uncommon for health plans to unknowingly let the PBM gain the upper hand in specifying audit terms.
Steve Baumgardner & Derek FryeTue, Dec, 17, 2019
Derek FryeTue, Jun, 11, 2019
Steve BaumgardnerTue, Jan, 16, 2018
Yvonne Zachman Fiedler & Derek FryeThu, Jun, 29, 2017
Lynn Stauffer & Derek FryeThu, Jun, 22, 2017
Serah Greenwalt & Derek FryeThu, Jun, 15, 2017
- CMS Issues New Proposed Protocols for Medicare Part C and D Program Audits and Part C Timeliness Monitoring Project. Proposed Changes Would Take Effect in 2021 Audit Year.
- How PBMs Make Money in the Medicare Part D Market – A GAO Report Analysis
- PBM Impact from COVID-19
- What Health Plans Need to Know about Medicaid Encounter Data
- Preparing Your Health Plan for 2020: A CMS Program Audit Checklist