Over the past few years, PBMs have increasingly hired third party companies – such as SCIO, Xerox, Conduent or others – to conduct pharmacy audits. Many times, these companies are compensated based on the amount of money they recoup on behalf of the PBM (thus, they are incentivized to find as many discrepancies as possible). They are given very little training and certainly are not made aware of applicable audit laws. Perhaps worst of all, they can be exceedingly difficult to get in contact with, creating challenges for pharmacies when responding to complex audits.
Ultimately, when dealing with auditing companies on behalf PBMs, pharmacies must take care to preserve their rights under applicable Fair Pharmacy Audit Laws, which often include prohibitions on compensating auditors in a manner tied to the total amounts recovered. Many of these laws also provide for set time tables during which audit results must be provided, as well as right to appeal. If you have a received an audit from a third party auditing company on behalf of a PBM, contact Frier Levitt today.