How Can I Prepare for a PBM Audit?

 Posted on September 26, 2019 in PBM Pharmacy Audits

The role of a pharmacy benefit manager (PBM) is one that is quite important in the health industry. PBM’s serve as the middleman between pharmacies and insurance companies and are necessary for a pharmacy to operate. Every once in a while, your PBM will contact you to inform you of an audit to ensure rules are being followed and business is being conducted as it should be. Being audited by anyone can be a nerve-wracking experience, especially if that audit is conducted by your PBM. A catastrophic PBM audit could leave lasting effects on your business. If you have been notified of an upcoming PBM audit, here are a few tips to help you prepare for your audit:‘

• Ensure you are there for the audit. When you receive notice of the audit, the exact date and time will also be mentioned. Make sure you are in the pharmacy at that time and that you are free to work with the auditor while they are there.
• Review the audit rules. Once you have received notification of the audit, you should review the audit section of the PBM’s manual. This section will contain information about the auditor’s procedures that you should be familiar with.
• Begin to organize your documents. In the audit notice, there should be a date range that the auditor will be focusing on. In some cases, actual prescription numbers will be provided. Be sure to have all records pertaining to the prescriptions filled within those dates and keep them in one place.
• Conduct a staff meeting. Not only should you be prepared for the audit, but your staff should also be prepared. Hold a meeting to inform your staff members of the date and time of the audit and of your expectations of them during the audit.

Concerned About an Upcoming Audit? Contact a Knowledgeable Illinois PBM Audit Lawyer

When it comes to any audit, especially a PBM audit, preparation is key for a successful outcome. If you have gotten notice of an upcoming PBM audit, you should contact a skilled Illinois PBM audit attorney. The Law Offices of Joseph J. Bogdan, Inc. has been helping clients prepare for PBM audits and advising clients of their next steps after PBM audits for more than 16 years. Being both an attorney and a registered pharmacist, Attorney Joseph Bogdan has the legal and medical knowledge needed to help you make the best decisions for your pharmacy. Call our office today at 630-310-1267 to schedule a consultation.

Sources:

http://www.gpha.org/wp-content/uploads/auditpreparation.pdf

https://join.healthmart.com/business-and-operations/making-audits-easier/

https://www.aprx.org/templates/aprx/Assets/aprx-advisor----the-on-site-audit.pdf