CONSULTING | AUDIT COMPONENTS
EHIM Consulting’s 360º PBM Audit Components:
Discount Evaluation - Verifies that you are receiving your contracted discounts on each and every prescription claim. All discrepancies are included in the Audit Report.
Plan Compliance - Verifies that only appropriate drugs are being covered under the plan and that the correct member copays are being applied.
Eligibility Verification - Verifies that only eligible members are receiving benefits through the pharmacy plan.
Clinical Program Compliance - Verifies that all clinical programs contracted under the plan, such as prior authorizations, step therapy or quantity limitation programs, are being conducted properly and are being invoiced accurately.
Rebate Guarantee Verification - Verification that your program is receiving the full extent of rebates guaranteed by your contract.