Pharmacy benefit management employer/Payer rebate compliance services

Download How can employers manage the complex process of ensuring pharmacy benefit management compliance with payer rebates (43kb)

Pharmaceutical pricing is under intense scrutiny from the government, payers and other sources. As a result, pharmaceutical managed care grows increasingly complex as Pharmacy Benefit Managers (PBMs) and Health Maintenance Organisations (HMOs) develop more sophisticated techniques to manage drug costs.

PricewaterhouseCoopers has developed and refined a state-of-the-art rebate testing program that helps payers critically evaluate drug utilisation rebates remitted from PBMs. Our programme evaluates the effectiveness of the payer’s contractual relationships with PBMs as well as the PBM’s techniques for managing pharmaceutical utilisation. PricewaterhouseCoopers has helped dozens of employers and HMOs to assess rebates paid by manufacturers to managed care accounts. Our assessments have uncovered hard cash discrepancies, incorrectly classified manufacturer rebates subsequently not passed on from the PBM to the payer, guarantee calculation discrepancies and other issues.