Pharmacy Benefit Managers
Medicaid audit reports involving pharmacy benefit managers, drug rebates, pharmacy claims, spread pricing, and pharmacy oversight.
Performance Audit Report: Pharmacy Benefit Manager Services for the Physical HealthChoices Medicaid Program in Pennsylvania
The audit identifies three findings with 17 recommendations. DHS generally disagreed with Finding 1 and agreed with Finding 2; PerformRx generally agrees with Finding 3. The auditors note ongoing conc...
Maryland Department Of Health Pharmacy Services Audit Report
MDH’s pharmacy services program exhibits governance and control weaknesses across manual claims processing, provider licensure verification, program audits, and MADAP rebates, leading to substantial o...
Poor Accountability and Transparency Harm Medicaid Patients and Independent Pharmacies
The audit identifies Oregon’s Medicaid PBM framework as overly complex and insufficiently transparent, with limited direct oversight of PBMs by OHA. The report recommends a shift toward stronger patie...
An Audit Report on Cook Children’s Health Plan, a Managed Care Organization
Cook Children’s Health Plan accurately reported STAR Kids medical and pharmacy expenses in FY 2020 and complied with eligibility requirements for medical and pharmacy claims. However, improvements are...
An Audit Report on Blue Cross Blue Shield of Texas, a Managed Care Organization
The audit found that while the Health Plan accurately reported medical, administrative, and quality improvement expenses, its pharmacy expense reporting was flawed due to unallowable practices by the ...