Auditing the administration of the rebate program, including dollars paid, is a proven strategy for improving plan sponsor profitability, prescription drug affordability, and the management of pharmacy benefit manager (PBM) contracts.
The purpose of a PBM rebate audit is to evaluate whether the PBM accurately invoiced the pharmaceutical manufacturers and then whether the correct rebate amount was paid to the plan sponsor for the audit period. Rebate audits identify lost or late revenue by focusing on the accuracy and timing rebate payments from pharmaceutical manufacturers to the PBM and subsequently the plan sponsor.
A comprehensive audit usually takes place in two stages. The first stage is a review of the claims for the audit period. In the second stage, consultants are typically required to travel on-site to the PBM’s location to review pharmaceutical manufacturer contracts.