PBM Audit Gap Analysis

Protect Your Pharmacy’s Future with the PharmaFortify® PBM Audit Gap Analysis

Mark Ziegler, Pharm.D., M.B.A., joined Boesen & Snow in 2019 after spending seven years leading audit teams at a major PBM. During his time there, he was directly involved in thousands of independent pharmacy audits, gaining deep insight into how PBMs approach and execute the audit process. Mark came to our firm with a clear mission: to help pharmacies not only respond to audits, but prepare for them proactively. That mission led to the creation of the PBM Audit Gap Analysis. Through this service, Mark and his team at Boesen & Snow will take your pharmacy through a comprehensive mock PBM audit—modeled on the exact methods used by PBMs.

With four different solution tiers—Platinum, Gold, Silver, and Bronze—you’ll choose the package that best fits your pharmacy’s needs and priorities. Each package delivers an individualized analysis of your high-risk areas, giving you targeted, actionable insights to strengthen your audit readiness. Along the way, you and your staff will gain valuable, hands-on training in how to navigate audits, interact with PBM auditors, and craft effective audit responses. With Mark’s insider knowledge and our team’s legal and clinical support, you’ll be equipped to face audits with confidence—not confusion.

PBM Audit Gap Analysis FAQs

1. I’ve operated my pharmacy for over a decade and have never had audit findings. Am I still a good candidate for a PharmaFortify® solution?

Yes! PBMs are constantly changing the goal posts for what is considered compliant under their provider manuals. It’s not a matter of if, but when an in depth PBM audit will occur testing your pharmacy’s ability to provide supporting documentation quickly and efficiently. In many cases, audit findings due to lack of compliance can lead to severe financial recoupments, leading up to potential contract termination. It is always wise to find any potential audit gaps before the PBM does.

2. What is the PBM Audit Gap Analysis?

The PBM Audit Gap Analysis is a comprehensive mock audit designed to help pharmacies prepare for PBM audits led by a former PBM auditor. Through this analysis, we’ll be able to determine your high-risk areas and compliance gaps that could put your pharmacy at risk for financial chargebacks and/or potential contract termination.

3. What does the process look like for the PBM Audit Gap Analysis?

First, you’ll complete a Pharmacy Survey Profile that details your pharmacy operations and where you need assistance. From there, you’ll have a consultation call with our Director of Pharmacy Services and a Boesen & Snow attorney. High level risk areas will be evaluated and discussed, and our team will then work with you to determine which tier best fits your pharmacy needs.

4. What’s the difference between your tiers?

Our service tiers are designed to meet your needs at every level—starting with high-level risk assessments and general advisory access, scaling up to focused desktop audits, and leading to a comprehensive compliance package that includes in-depth prescription documentation review, drug invoice reconciliation, SOP analysis, and both desktop and onsite mock audits to ensure you’re fully prepared and protected. As part of our full-service offering, your pharmacy staff will also receive real-world audit training to build confidence, sharpen compliance skills, and learn best pest practices while undergoing the mock audits.

Interested in learning more? Schedule a free consultation by submitting the form below.