MHA is considered by many to be the premier pharmacy benefit consulting and auditing firm in the United States, because we focus exclusively on pharmaceutical consulting and auditing. MHA offers a breadth of services that exceeds that of our competitors. Our principal business includes TPAs, Insurance Plans, Union Benefit Plans, BlueCross BlueShield Plans, County, State and Federal Governments, among others. We continue to be on the cutting edge of Pharma Industry practice having performed computer forensic work for the Department of Justice (DOJ) and the Federal Bureau of Investigation (FBI).
The size of our individual Client base ranges from less than 25,000 members to over four (4) million lives. We are currently providing services to Clients that collectively incur more than three (3) billion dollars in pharmaceutical expenditures annually.
Unlike our competitors, we offer a full suite of cost control solutions proven for our Clients. Our wide range of PBM audit options includes PBM contract negotiations, recovery audits, fraud and abuse identification and comprehensive consulting services. Since we provide all types of PBM industry audits, we are familiar with many aspects of the Pharma Industry and its hidden business practices. We use pricing histories from reputable sources such as First Data Bank and Redbook along with Drug Enforcement Agency Files (DEA), National Association of Board of Pharmacists (NABP) numbers and state licensure files.
Over the last three (3) years as a result of our PBM audits, we have identified between 15%-25% in the commercial Clients that we have audited, (i.e. the big 3 PBMs, Medco, Express Scripts Inc, CVS/Caremark). As a result of these comprehensive PMB audits, our Clients have recovered millions of misspent program dollars and continue to reduce their prescription spend moving forward.
Our proven experience and acute understanding of the challenges that are present in the Pharma Industry allows us to recognize and provide the services that you need.
In the PBM audit process whether it's prospective or retrospective, success is measured in one way...recoveries.
Examples of some common PBM recoveries:
- Spreads kept by the PBM (Difference between payments to pharmacies and reported billings)
- Formulary steering to much higher cost medications for incentives
- Failure to verify prescriber ID's on drug claims limiting the ability to audit (20% to 30% of claims contain an invalid prescriber ID)
- Creating floats within the reimbursement structure (Interest is kept by the PBM)
Documented examples of identified savings for our clients through PBM audits are detailed in the table below:
| Year |
Total
Recovery/Savings
Identified |
| 2006 | $94.7 Million |
| 2007 | $23.3 Million |
| 2008 | $32.0 Million |
Using our robust technology, clinical driven rules engine and pharmacy professionals, let us show you how we can help you recover the lost dollars and identify fraudulent activities in your networks.
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