Support from the notice through the response
A PBM audit can involve an on-site visit or a remote request for records. Our work starts with understanding the notice, the claims being reviewed, the response deadline, and the records available. The engagement can cover document organization, purchase substantiation, findings review, rebuttal preparation, and appeals support. The scope is agreed before billable work begins.
Build the response from your own records
We compare the auditor’s findings with pharmacy purchase and dispensing records, reviewing flagged claims at the National Drug Code (NDC) level. The analysis can include equivalent products, pack sizes, and units of measure. Where the records support a challenge, we organize the underlying evidence so the disputed finding can be reviewed claim by claim.
What to have ready for your first conversation
Have the audit notice, response date, payer or PBM name, and any claim list or findings available. If the matter involves an overpayment demand, tell us the amount being disputed. Your first call helps define which records and services are needed; do not enter patient information into the website worksheet.
Know the scope and cost before work starts
Audit defense is $295 per hour. The initial 30–60 minute phone or Zoom consultation is free, one time. Before billable work starts, we provide a written estimate and firm cost cap. Invoices include itemized time logs. Legal representation, when needed, is provided through licensed attorneys under a separately scoped engagement, starting from $495 per hour.
Questions about pbm audit defense
Do you handle desk audits as well as on-site PBM audits?
Yes. Pharma360 supports remote desk audits and on-site PBM audit responses, including document preparation, purchase substantiation, findings rebuttals, and appeals support.
Can Pharma360 guarantee that a recoupment will be reduced?
No result is guaranteed. We review the findings against the available records and contest amounts the evidence supports challenging. The outcome depends on the facts and the payer’s review.
Can a pharmacy outside Pennsylvania work with you?
Yes. The Philadelphia-based team serves independent pharmacies in all 50 states by phone and Zoom.
Published by Pharma360 Solutions LLC · Updated . Consulting information; legal representation is provided through licensed attorneys.