PBM Audit - Expose What Your Pharmacy Benefit Manager Isn’t Telling You
Our advanced AI-powered audit system identifies discrepancies and optimizes your pharmacy benefit expenses.
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Audit PBMs with ease
Pharmacy benefits represent a significant portion of healthcare costs. Yet many organizations overpay due to complex contracts, hidden fees, and underperforming guarantees. Our PBM Audit solution gives you visibility, control, and leverage to ensure you get what you’re paying for.
How It Works
Upload your PBM Contract
Simply upload your Pharmacy Benefit Manager contract document (PDF or image). Our sophisticated AI system extracts key terms, clauses, and guarantees automatically.
Review & Edit Contract Terms
Verify the extracted terms and make any necessary adjustments. Our system tracks all edits for complete transparency and compliance.
Compare Contracts vs. Actual Performance
We analyze your actual claims data against contract terms to identify discrepancies. Areas where your PBM isn’t meeting obligations are clearly highlighted.
Explore Actionable Insights
View detailed analysis including AWP discounts, rebate guarantees, rebate exclusions, dispensing fees, and administrative fees. Identify specific opportunities for contract improvements.
PBM Audit
You’ll need your PBM contract document (PDF preferred) and 10-15 minutes to complete the initial review.
Frequently asked questions
Which input formats can I use to upload my PBM contract?
Our platform supports a wide variety of file formats—PDF, images, Word documents, and more. Simply drag and drop your contract, and our system will parse the information automatically.
What types of discrepancies does the PBM Audit usually uncover?
The audit frequently identifies hidden or inflated administrative fees, unfulfilled rebate guarantees, incorrect AWP discounts, and other contract loopholes. You’ll see exactly where you may be overpaying and how to negotiate more favorable terms.
What can I do if the audit reveals significant issues in my PBM contract?
You’ll receive a detailed dashboard highlighting each discrepancy, its financial impact, and potential savings. These insights allow you to renegotiate contract terms, address underperforming guarantees, and ensure you’re receiving all promised benefits.
Can this solution provide ongoing oversight, or is it only for a one-time audit?
Our system supports both one-time and ongoing analyses. Once your contract and claims data are uploaded, we can monitor changes, track performance guarantees, and continuously provide insights to help you maintain optimal PBM arrangements over time.
