As pharmacy benefit manager (PBM) reform efforts continue to evolve, pharmacies remain under increasing pressure to understand and navigate the audit processes that can significantly impact their operations and long-term viability. PBM audits can result in monetary recoveries, network restrictions, and other consequences that make proactive compliance and audit preparedness essential for pharmacies seeking to protect their businesses.
In an episode of Drug Topics’ Over the Counter podcast, Harini Bupathi discussed the realities of PBM audits and why pharmacies must take a proactive approach to compliance and audit defense. Harini explained that audits are often used for purposes beyond identifying fraud, waste, and abuse, noting that network termination can be an even greater threat than financial recoupment because it may trigger additional scrutiny and disclosure obligations with other PBMs. She also explored how the Consolidated Appropriations Act of 2026 could influence future PBM oversight and potentially reshape audit practices moving forward.
