Pharma360 Solutions helps independent pharmacies fight desk audits, overpayment demands, Medicare & Medicaid audits, and PBM audits. Every response is built on claim level data analysis designed to hold up. And when a matter escalates, we provide legal representation through licensed attorneys.
Deadlines matter. Here is what to do today:
From audit defense to daily operations, we work exclusively with pharmacies. Every recommendation comes from someone who understands how a pharmacy actually runs.
Desk audits look routine until the findings letter arrives. We handle document requests properly the first time, complete, organized, and on deadline, so a paperwork review never turns into a recoupment demand.
An overpayment demand is a starting position, not a final number. We reconcile the auditor's findings against your purchase and dispensing records, identify what is actually substantiated, and fight the rest, line by line.
Government payer audits carry the highest stakes, including potential referral for further review. We prepare responses for Medicare and Medicaid audits with the documentation rigor these programs demand, and legal representation is available when the situation calls for it.
Our signature service: custom reports that reconcile purchases against dispensing, matching every claim to invoices at the NDC level while accounting for equivalent NDCs, pack sizes, and units of measure that auditors routinely get wrong.
OUR SPECIALTYBeyond audits: from opening a pharmacy from scratch to tightening an established operation. Licensing and enrollment guidance, policy manuals, compliance programs, inventory controls, and the record keeping habits that prevent audit problems before they start.
On site and remote PBM audits can put large recoupments on the table. We manage the entire response: document preparation, purchase substantiation for every flagged claim, findings rebuttals, and appeals. When a matter needs legal muscle, we provide legal audit defense through licensed attorneys.
MOST REQUESTEDThe best defense starts before any notice arrives. We audit your pharmacy the same way a PBM or payer would: reconciling purchases against dispensing, testing your documentation, and reviewing your billing patterns. You get a clear report of what an auditor would find, and a plan to fix it, so when an audit hits you are already prepared.
BE READY BEFORE THEY KNOCKYou will never wonder what we are doing or what it costs. Every engagement follows the same four steps.
A free 30 to 60 minute phone or Zoom consultation, one time only. Describe your situation and we give you an honest read on where you stand.
Before any billable work begins, you get an hour estimate with a firm cost cap. No open ended bills, ever.
We build your response from your actual data: invoices, dispensing records, and claim files, documented so it can withstand scrutiny.
Every invoice comes with an itemized log of the hours worked and what each hour produced. You see exactly what you paid for.
Your engagement stays organized from the first review through documentation, reconciliation, rebuttal, and follow-up.
Auditors work from aggregate numbers. We answer with claim level detail. Our custom built reports turn your raw pharmacy data into evidence.
We turn invoices, dispensing data, NDC detail, and auditor findings into clear evidence that can be reviewed claim by claim.
Every dispensed claim matched against wholesaler invoices within the audit window, NDC by NDC, with equivalent NDC crediting, pack size corrections, and unit of measure review that auditors' models skip.
Identifies claims billed under one NDC but dispensed from an equivalent product purchased under another. This is a leading source of inflated shortage findings, and one of the strongest rebuttal angles available.
A defensible dollar figure for your true exposure, separating confirmed items from disputable ones, so you negotiate from facts instead of the auditor's worst case number.
Response workbooks for every flagged claim, formatted the way PBMs and payers expect: claim reference, substantiating invoice, quantity math, and supporting documentation, ready to submit.
Hourly billing with a written estimate and a firm cap before we start. You approve the scope, and we do the work.
Operations, compliance, reporting & general pharmacy consulting
Desk, overpayment, Medicare/Medicaid & PBM audit engagements
Ongoing support for pharmacies that want us on call
Legal representation available with licensed attorneys
Your first phone or Zoom consultation, 30 to 60 minutes, is free, one time only. You will know where you stand before you spend a dollar.
Every engagement starts with a written hour estimate and a cap we will not cross without your approval.
Every invoice shows the hours worked and what each produced. Full transparency, every time.
Pharma360 Solutions was built by people who run pharmacies, not by outside analysts reading about them. With 33 years in the pharmacy business, our experience comes from operating independent community pharmacies, defending them through the same PBM, desk, and payer audits our clients face, and putting struggling pharmacies back on track.
That is why our approach is different. We know what a dispensing report actually contains, how wholesaler invoices really map to claims, and where auditors' aggregate models break down. When we challenge a finding, it is because we have reconciled the data ourselves, line by line.
Based in Philadelphia and serving independent pharmacies nationwide, we exist for one reason: to make sure no pharmacy has to face a PBM or payer alone.
Pharmacy people, defending pharmacy people. Our team has spent decades behind the counter and across the audit table.
33 years operating independent pharmacies and defending them through PBM, desk, and payer audits.
33 YEARS OF EXPERIENCE30 years of pharmacy practice and audit expertise, guiding independent pharmacies through compliance reviews, PBM audits, and payer disputes.
30 YEARS OF EXPERIENCE10 years turning raw pharmacy data into NDC-level reconciliation reports that hold up under audit.
10 YEARS OF EXPERIENCE10 years managing PBM, desk, and payer audits from first notice to final resolution.
10 YEARS OF EXPERIENCERepresents pharmacies in disputes with insurance companies and PBMs — negotiating recoupments down and managing appeals.
ATTORNEY & NEGOTIATORA free 30 to 60 minute phone or Zoom consultation, one time only. Tell us what you are facing and we will respond within one business day.