Audit Leads to Program Improvements

A Contract and Plan Design Compliance Audit results in savings from retrospective recoveries and using the audit results to renegotiate and amend the existing PBM contract.

A Fortune 100 company trusted TRICAST to produce their annual PBM audit of vendor contract and plan design compliance. The audit of their pharmacy claims verified vendor accuracy for both contract pricing and plan designs. Our audit also identified some opportunities for program improvement that, based on our recommendations, were implemented soon after.

Small recoveries were made for claims paid outside plan design, but this client found major value in the audit in:

  • Cost savings when compared to their prior auditor.
  • Immediate cost reductions through greater adherence to appropriate claims adjudication criteria, which were provided by TRICAST staff.
  • The audit also became an integral part of this company’s Sarbanes–Oxley Act compliance.

“The TRICAST staff is terrific. They are probably our most responsive and cooperative vendor of services.”