Boesen & Snow, LLC

Audit Pharmacy Services

If your Pharmacy is being Audited or has been notified of an audit. Please click the box below, your responses will be immediately sent to our PBM Audit Specialist

PBM Audit Best Practices : Tips for PBM Audits from an Industry Insider

The primary goal of the PBM Audit is to uncover discrepant claims in which the PBM will recoup money paid to your pharmacy. What most pharmacies do not realize, is that the results of these audits can potentially lead to a termination of your PBM Contract. All adjudicated claims are subject to audit regardless of the fact the claim paid. BSL offers proactive methods to help you mitigate the financial pitfalls you may encounter as the result of an audit. These measures will not only help decrease the potential for audit chargebacks but they will also show you how to run a more “PBM Provider Manual” compliant operation.

The key points in mitigating PBM audit findings include:

What the other audit services are not telling you:

Imagine you are driving in your car and to the best of your knowledge are obeying all traffic laws. The police pull you over and without providing you a reason for doing so begin to question you and demand to search your vehicle. You are within your rights to demand the reason you have been stopped and the refusal to answer any questions or submit to a search. Likewise, you would not begin to offer information to the officer on a whim.
PBM Auditors are very much the pharmacy claims police. You are required to provide the documentation requested per your Provider Agreement but, in many cases, it is the information you provide without realizing it either through additional questioning by the auditor or casual conversation can also be used against your business. Onsite auditors are the eyes and ears of the PBM because they physically enter your pharmacy. They may ask roundabout questions during normal conversation to fish for information and are observing the actions of your staff for any type of operating procedures that may not be within compliance of your provider agreement. If the auditor senses anything may not be compliant or wishes for a deeper investigation, they may refer your pharmacy to an investigative desktop auditor. Likewise, requesting the auditor provide nonroutine questions to you in writing will help ensure accurate and concise responses, something BSL can advise and guide you through.
BSL has extensive pharmacy, PBM, and legal experience which is leveraged to help your business run both efficiently and within compliance of your PBM Provider Agreements.


Pharmacy Operations- Prospective Audit Preparation

General Housekeeping

Inventory Management


Standard Billing Practices

Help prepare pharmacy specific Policies and Procedures if applicable

Retrospective- Audit Response

Assess Initial Audit Notification

Advise on appeal response to Initial Audit Findings

Advise on responses to respective PBM Pharmacy Membership Review Committee notification

Documentation for Response

Hard Copies

Signature/Delivery Logs

Pharmacy Licenses

Copay Collection


Post Audit Functions

Initial Audit Findings Response Assessment Based on Discrepancy Type

Invoice Shortages

Shipping without Licenses

Copay Collection

Prescriber Denied Claims

Member Denied Claims

Miscellaneous Discrepancy Types

Other PBM Services Offered

Other Pharmacy Services