According to the National Community Pharmacists Association, nearly 85 percent of prescription drug claims are paid (at least in part) by someone other than the person taking the drugs. These third-party payers — employers, health plans, government programs and pharmacy benefit managers — all have a stake in making sure prescription drug claims are processed and paid correctly.
Audits help ensure that pharmacy procedures are consistent with contractual and regulatory requirements and that payments are accurate. By detecting common claim handling errors, audits also help to reduce drug waste, fraudulent claims, or other mistakes that can add significant costs into the health care system.
With the growth of third party payers and expanded government regulation of health care, pharmacy audits have become more frequent, more rigorous and more consequential. Increased pressure has caused distrust of auditors to grow, and given audits a bad name.
This is one reason Prime has invested in making pharmacy audit practices easy to use and pharmacy-friendly. We take great care to make audits fair and objective, and want to make it as easy as possible to work with us. Our audit program includes education designed to help reduce and eliminate errors. Our auditors work to make transparency and respect the foundation of audit interactions and procedures. Read our pharmacy audit position paper to learn how Prime is turning audits — a source of potential antagonism — into a venue for greater collaboration with pharmacies.