Don’t pay or agree before you check the math
Recoupment amounts are often built from aggregate calculations. Common problems include equivalent products bought under a different NDC, pack-size differences, and unit-of-measure errors. Before accepting a figure, it is worth knowing what your own records actually show.
What the review produces
We match every flagged claim to the purchase invoices in the audit window, identify NDC mismatches, and calculate a defensible exposure figure. You get a clear picture of which findings are supported, which are disputable, and why, so you can respond or negotiate from facts rather than the auditor’s worst-case number.
From analysis to response
We prepare a rebuttal package for each disputed claim: the claim reference, the supporting invoice, the quantity math and the documents behind it, in the format PBMs and payers expect. If the dispute escalates, licensed attorneys can negotiate and handle appeals under a separate scope.
Cost, and what to have ready
Audit defense is $295 per hour, with a written estimate and firm cost cap before work begins. Have the demand letter, the amount, the deadline and any claim list ready for your free consultation.
Questions about recoupment & overpayment disputes
Can a PBM recoupment amount be reduced?
Sometimes. The amount in a demand reflects the auditor’s calculation. When the pharmacy’s invoices and dispensing records support the claims, those findings can be contested. No reduction is guaranteed; it depends on the records.
What is the difference between a recoupment and an overpayment demand?
Both are requests to repay money for claims the PBM or payer says weren’t supported. A recoupment is often taken by offsetting future payments; an overpayment demand usually asks the pharmacy to pay the amount back.
How quickly should I act on a recoupment demand?
As soon as possible. Demands usually come with a response deadline, and the earlier the records are reviewed, the more options you have. Call (267) 809-2396 for a free consultation.
Published by Pharma360 Solutions LLC · Updated . Consulting information; legal representation is provided through licensed attorneys.