Pharmacy Plan Audits
Is your PBM Performing?
If your Pharmacy Benefits Manager (PBM) isn’t performing, we want to help. Our in-depth, comprehensive audits can help uncover missteps in plan performance, and keep your benefits plan running smoothly. With the ability and expertise to analyze and uncover your plan’s cost drivers, our experienced team leaves no stone unturned. CobaltRx offers the following types of audits:
Financial Audit
Focuses on contract elements like negotiated discounts, MAC list application, dispensing fees, Administrative fees, etc.
Rebate Audit
Focuses on the financial and procedural accuracy of rebate reimbursement based on the contract.
Clinical Program Audit
Focuses on the proper application of prior authorizations, quantity limits, excluded drugs, and step therapy.
Plan Design Audit
Focuses on the proper adjudication of copays, coinsurance, and deductibles.
Eligibility Audit
Focuses on making sure all adjudicated claims were for eligible members on the data of fill.
Performance Standards Guarantee Audit
Validate the service guarantees in the contract, to include: customer service answer times, mail service days to fill and delivery, etc.
