Services - Invoice Reconcilliation Audit Services (IRAS)

IRAS provides auditing services to regional and mid sized chains to make sure the pharmacy benefit managers (PBMs) are reimbursing according to the terms of the contract.

IRAS helps Chief Financial Officers, Owners, Marketing Departments and Pharmacy Managers within pharmacy chains to ensure that reimbursements are correct and market competitive. Pharmacy Outcomes Specialists audits 100% of the electronic transactions from PBMs to ensure:

• Brand Pricing – are the discounts being taken according to MediSpan or Frist DataBank on the date of dispensing accurately in terms of the contract between your pharmacy and the PBM?
• Generic Pricing – is the MAC pricing competitive and realistic given acquisition costs?
• What NDC’s provide the greatest margin from which PBMs?
• What contracts between your pharmacies and the PBM industry need improvement?
• Can retroactive adjustments be made to payments?
• What are your audit rights?
• Are PBMs honoring “special” arrangements for certain clients or lumping all clients into special deep discounts arrangements?

IRAS can assist in the negotiation with PBMs for an entire book of business or a particular important patient group. Pharmacy Outcomes Specialists has been successful in increasing the bottom line in pharmacy reimbursement by a 30% increase in just contract renegotiation and enhanced terms and audit recoveries.