Best Practices for Proactively Preventing PBM Audit Issues | NCPA 2024
Trent Thiede, PharmD, MBA, president of PAAS National, discusses best practices that pharmacy teams can implement to proactively prevent audit issues before they arise.
Pharmacy Benefit Managers (PBMs) routinely conduct audits on independent pharmacies with the stated goal of preventing fraud, waste, and abuse in medication dispensing. However, PBM audits often lack clear metrics and can include certain requirements without an explicit reason why. As these audits increase—in 2023 they shot up by as much as 29%1—many pharmacists who have failed them cite it as the primary reason why they can’t stay in business.2
At the National Community Pharmacists Association (NCPA) 2024 Annual Convention and Expo, held October 26 to 29 in Columbus, Ohio, Trent Thiede, PharmD, MBA, president of PAAS National, gave a presentation titled “Equipping Your Team for Typical and Atypical PBM Audit Scenarios,” in which he reviewed the latest trends in PBM audits and shared tips to proactively mitigate and respond to them.
Drug Topics sat down with Thiede at the meeting to talk about his presentation, as well as some common reasons independent pharmacies face audits from PBMs, and best practices that pharmacy teams can implement to proactively prevent audit issues before they arise.
“One of the core things is taking a team approach to audits,” Thiede said. “We talk a lot about training [because] it’s a staff effort. It’s not one person that is going to catch every single thing. It’s really involving your team—from your cashiers…to your billing staff…and even your filling staff…It’s a team approach.”
“It’s not just the pharmacist that is dispensing that needs to play the role,” he added. “It should be a team approach.”
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