We love audits: Keeping an eye on PBMs

Pharmacy Benefits Podcast

The word “audit” sends shivers down peoples’ spines. It evokes fears of the IRS, more taxes and possibly even repossession. But in the world of pharmacy benefits, audits are an entirely different issue, according to Brian Bullock, president of The Burchfield Group.
Errors can occur in the way the pricing or pharmacy benefit plan is set up, or in the way the benefit is delivered. Also, the logic that drives these benefit systems can be faulty, Bullock said, so the benefit you thought you had signed up for may not be what your employees are getting at the point of sale in the pharmacy.
“It’s all about accountability and ensuring that plan sponsors get what they expect from their pharmacy benefit managers,” Bullock said. Bullock and Deanna Mendelow, vice president at The Burchfield Group, discuss the purpose and the importance of pharmacy benefit audits in today’s installment of the Pharmacy Benefit Podcast, available for free at www.burchfieldgroup.com.
“Plan administrators will ask, ‘What is special about Pharmacy Benefit audits?’ ” Bullock said. “The complexities behind PBM processing and the intricacies of PBM pricing create a scenario in which employers cannot be sure that their money is being spent appropriately. They need to ensure that their employees are getting the drug coverage they expect.”
Bullock invites listeners to submit questions and comments, which they will address in subsequent podcasts. Send an e-mail to [e-mail] or call 651-389-5640.