Dae Y. Lee and Harini Bupathi Published in Chain Drug Review: “Avoiding Pharmacy Audits”
Pharmacy benefit managers (PBMs) regularly conduct audits on pharmacies to review their performance in relation to the PBM’s terms and conditions. There are several different types of compliance audits that PBMs may initiate, such as desktop, on-site, invoice or virtual. In order to be prepared for audits, pharmacies are encouraged to proactively undertake efforts to ensure compliance with the PBM’s Provider Agreement and Provider Manual, including those identified in the PBM Audit Checklist.
Generally, audits are routine and occur during similar times throughout a pharmacy’s participation in a PBM network to ensure general pharmacy compliance. While some PBMs will conduct audits directly, others will contract with third-party audit companies to assist in the process.
In this article published by Chain Drug Review, Frier Levitt’s Dae Y. Lee, Esq., Pharm.D. CPBS and Harini Bupathi, Esq. discuss several reasons why a pharmacy may be “flagged” or audited and explore some scenarios that may lead to an audit.
Read article here.