Pharmacy benefits audits are powerful tools to better understand this significant source of plan costs. Our audits not only result in recovered expenses but can lead plan changes for future cost reduction. Pharmacy testing includes:

  • Pricing Audits — We apply our own average wholesale price (AWP) source to ensure that we catch errors in AWP sourcing. This portion of the audit also focuses on dispensing fee tests and exclusions such as single-source generics and specialty drugs.
  • Benefits — We not only test for charges that are not covered, but also prior authorization requirements, step therapy, benefit maximums, copayments and special areas such as Dispense as Written penalties. Plus we recommend potential changes to the plan to make it more consistent with the client’s intent.
  • Rebates — J. Graham Inc. reconciles per script rebates as a standard part of all pharmacy audits. Any pass-through testing is custom designed and quoted based on the audit rights at the pharmacy benefits manager.

J. Graham Inc. team

See our audit process for more information about our approach, or contact us today to discuss your options.

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