PHARMA INDUSTRY RISK FACTORS
Pharmacy Benefit Manager Risk Factors
- Contractual Audits
- Business Practices
- A few of those practices that siphon money and drive up Rx Spend
- Exclusions and prior authorizations
- Professional and administrative fees
- Mail vs Retail price differences
- Usual and Customary Charges
- Formulary overcharges
- Duplicate Payments
- Package Size Errors
- Member Eligibility
- Co-payments
- AWP Pricing
- MAC Pricing
The solution? "Contract MHA to apply their Computer Forensics to the complete audit process!"
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