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PBM Pricing Audits: Key Emerging Contract Practices and Protocols

Presenters: Derek Frye, Audit & Compliance Practice Leader and Lynn Stauffer, Audit & Compliance Audit Lead


This event has ended. The slides are published here, and the recorded session is accessible here.

Health plan contracts with PBMs are more complex and harder to navigate than ever. Plus, the ever- evolving contract provisions PBMs present to health plans to approve -- especially related to claims pricing payments and reconciliations – can negatively impact plans’ bottom lines without you even realizing it.

Please join The Burchfield Group to learn about the value of conducting PBM pricing audits, the importance of having strong protections in your PBM contracts concerning audit rights and protocols, and why it’s critical to complete a 100% valuation of all PBM contract terms that can impact your claims pricing.

In this webinar, you will learn:    

  • The three critical components you need from your PBM in order to complete an accurate pricing reconciliation – and how to obtain these.

  • Emerging PBM contracting pitfalls to be aware of – as observed by The Burchfield Group during the past year of pricing audits performed by our procurement experts.

  • How health plans can spot and avoid these “gotchas” in your PBM contracts.

  • How to protect your plan during future PBM contract negotiations.