Pre-Audit Saves a Million

Using the TRICAST data warehouse and our industry experience, we re-negotiate your current PBM contract or conduct a full market search for a new PBM.

For large plans, this process typically results in 2-3% in annual pharmacy benefit savings from reducing the overall pricing elements of the contract and increasing the manufacturer revenue sharing.

In an RFP process for a health plan with 400,000 lives, our “pre-audit” of claims forced a PBM to agree that the offered contract pricing for specialty pharmacy medications at retail did not match their offering in their response to our claims re-pricing. This resulted in an annual savings to the plan of $1.3 million.