Pharmacy Benefit Manager (PBM)
Forensic Audit
Optimize Your Pharmacy Benefits and Maximize Savings
RECOVER REVENUE. REDUCE COSTS. ENHANCE TRANSPARENCY.
Our Pharmacy Benefit Manager (PBM) Forensic Audit service provides organizations across all industries with in-depth insights into their PBM contracts, identifying hidden costs, missed performance guarantees, and optimization opportunities. With a simple and streamlined process, we empower clients to ensure that they receive the maximum benefit from their PBM agreements without changing providers or disrupting employees.
Significant Cost Savings
Uncover Hidden Fees
Enhanced Transparency
Contingency-Based Model
Why a PBM Forensic Audit?
Managing prescription drug benefits is a complex and time-consuming task, especially with evolving drug therapies, costly specialty drugs, and intricate pricing terms. Many organizations face challenges in identifying hidden fees, overcharges, or contract discrepancies. With our PBM Forensic Audit, we uncover these issues and ensure that your organization’s prescription drug spending is optimized.
Key Benefits
1.
Identify Missed Performance Guarantees - Our Audit reveal any discrepancies in PBM performance, ensuring you recover missed savings and prevent future losses.
2.
Uncover Hidden Fees - Identifies undisclosed fees, overcharges, and inflated pricing to ensure your funds are spent efficiently.
3.
Enhanced Transparency -
A detailed analysis bringing clarity to pricing structures, rebate pass-throughs, and admin costs.
4.
Modified Contingency-Based Model - Our approach includes a nominal implementation fee, which is fully recouped back to you before any contingency fees are applied.
How It Works
01
Send Us Your PBM Contract
Begin by sharing your current PBM contract with us for a full analysis.
02
Direct your PBM to Send Us Your Claim Data
We work with your PBM to obtain claims data, allowing us to thoroughly audit contract adherence and performance.
03
Receive Monthly Monitoring Reports
Each month, you receive detailed reports that highlight areas where savings and recoveries are possible, ensuring transparent tracking and ongoing benefit.
04
Recover Money from Your PBM
Identify recoveries of missed performance, reclaim funds, and optimize future spending.
Why Choose Us?
Prescription drug benefits are highly complex, with dynamic drug therapies, high-cost specialty medications, and opaque contract terms. Most HR generalists or benefits administrators struggle to manage these plans effectively, often missing potential savings.
CG Moneta Consulting has partnered with Pharmacy Investigators & Consultants (PIC), a leader in pharmacy benefits consulting with a long-standing reputation for protecting client interests. We are a group of pharmacists, accountants, technicians and criminologists that uncover waste and abuse in pharmacy benefits. Our proven consulting services are unique and help clients save a minimum of 10% of pharmacy costs without disruption. Our services are paid by clients, not PBM commissions or “marketing credits” leaving us unbiased and objective.
Report Monitoring Services
Our comprehensive reporting and monitoring provide clients with valuable insights into their PBM programs, including:
- Audit of PBM Performance to Contract Guarantees
We verify adherence to contract terms, such as discounts, dispensing fees, and rebates, ensuring your PBM meets performance guarantees. - Top Costly and Used Brand and Generic Drugs
Identify the most expensive and frequently used medications to optimize formulary design and manage costs effectively. - Top Pharmacies and Patients
Gain insights into high-cost pharmacies and patients to better understand spending trends and opportunities for targeted interventions.
Technology Solutions
Our technology solutions streamline the process, providing clients with easy access to insights and data:
- The Pharmacy Report Card
We provide clients with a monthly report card that includes essential metrics and insights, helping you track performance and savings. - Automated Data Integration
PBMs upload data directly to our secure platform, where reports are generated and sent to clients automatically. - Data Comparison with Contract Terms
Our technology matches claims and data to PBM contract terms, ensuring continuous oversight and recovery of missed savings.
