Prepare Your Pharmacy for PBM Audit

Working in a pharmacy is something that can be stressful, hectic, and complex at times. As a pharmacist in the field, there are many regulations you have to follow for health and safety. In addition, many audits and inspections are completed that will determine the success of your establishment. 

Today we want to talk about a specific audit that often takes place in the pharmacy industry known as a PBM audit. A PBM audit, or pharmacy benefit manager audit, aims to find discrepancies in your business that the PBM can recoup. The main issue with PBM audits is that you stand a chance to lose your PBM contract when it is carried out, which can spell trouble for your business. 

When managing a PBM audit, it is easy to fall into some legal and financial pitfalls. Still, it is essential to be prepared for the audit, and this might help save your business, ensure you can pass your audit, and ensure that the pharmacy is compliant and safe for all. 

PBM Auditors are people to watch out for as a pharmacy as they will take any excuse to make claims. Therefore, you need to have your documents on hand when facing an audit and avoid saying anything in casual conversation that may reveal information you didn’t want to share. Unfortunately, this is a common misstep that many pharmacy owners take, and it can cost you money in the long run if anything you say is used against you. 

How do you prepare?

If you have received a notice of an impending PBM audit to your premises, there are a few different ways you can prepare for this. Today we want to show you some of the steps you can take to ensure that you are ready as a business for your audit. 

Hire an attorney

One of the best steps you can take before an audit is to hire a skilled PBM audit defense attorney. They will be able to talk you through the process and the things that could be spotted and make sure that you are prepared for any eventuality. Getting a professional opinion is always a practical use, and it will ensure that you don’t get caught out should you forget anything when the auditor comes to your door. 

Review the notice 

When you want to prepare for your audit, it is first essential to look at the notification that has been sent through to you. This will give you some detail about the scope of the audit that will be carried out, and this means you can gain some valuable information about where to focus your attention in the lead-up to the audit. In addition, the terms of an audit will be stated in full in the letter, so make sure you take time to read this and share the information with your attorney, too, so that they may give you some advice. 

Check for the date 

Now is the time for you to see when the proposed date of an audit has been set. This is an essential step because, of course, you will need to take some time to prepare your pharmacy for an auditor to visit. It is imperative in this step that you ensure the most senior staff members are on-site because this is not something the junior team will be equipped to deal with. Be present and put your best foot forward on the day and it will work in your favor. 

Compile documents 

Now is the time for you to start filing all of your important documents together in preparation for your audit. Your PBM auditor will require you to give them a few different documents during the audit, such as your records, notes, and licenses, so make sure they are all in order and ready to hand over. One helpful thing to also do is keep a filed record of the audit documents themselves. This means taking records of phone calls or emails, storing the audit records, and ensuring you have all of your information accounted for. This will help you should you get into a legal issue after the audit. 

Prepare your staff 

Your staff may not have ever dealt with an audit before, and now is the time to ensure they are ready and on their best behavior. But, first, hold a meeting and ensure everyone knows how to act, prepare, and do.

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Kyle Wolfe

Author/blogger residing in Indianapolis, IN and sometimes in Chicago and Detroit. I really enjoy urban settings. You'll catch me at the local sushi bar, and testing out local wines and craft beers. Coffee bars are nice, and my goal is moving to the west coast before too long. If you must know, I prefer Mac over PC.
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