All Pharmacy owners should know about is a PBM audit. These audits happen when you first sign up for a contract with a PBM, such as Express Scripts, CVS Caremark, and Optum RX. The PBM audits will take place randomly, and their job is to ensure you’re “doing the right thing.”
The best bit of advice the experts at SAPG Legal can provide is to watch and make sure your inventory reports are accurate! Your wholesales should always be on call to send any invoices.
When the investigator visits, they’re looking to see that everything your pharmacy is doing is on the up and up. But be aware that investigators do receive incentives when they find issues.
Because of this, you must always read the report once they leave to catch any instances of false information stated in the reports. Some reports have lied about licenses being up to date and dispensed reports or wholesale reports with mismatched dates to indicate an error, such as an inventory shortage. Be careful with investigators, and don’t hesitate to contact a legal team in your area with any questions!.