Why prescription benefit plan sponsors should audit
Many sponsors of prescription drug benefit programs have operated on blind faith for too long. They have depended on their pharmacy benefit manager (PBM) to deliver safe and effective prescription drug coverage to their plan members while helping to reduce costs. The problem occurs when the plan sponsor relies on their PBM to tell them how they are doing! This is something akin to the fox guarding the hen house.
To make matters worse, prescription benefit programs and PBM business practices remain some of the most opaque operations in health care. It is almost impossible for a plan sponsor to fulfill their fiduciary obligations without some type of independent, third-party oversight. This is where outside auditing and monitoring comes into play.
Let’s take a look at the reasons why: