Solution allows clients to track PBM performance by implementing several new audits
NEW YORK, NY—June 12, 2018— Truveris, Inc. today announced new audit capabilities geared towards further increasing transparency in the pharmacy benefit space. TruAudit™ allows clients to track PBM contract performance with a diverse audit portfolio, expanding Truveris’ comprehensive suite of solutions designed to manage the lifecycle of a pharmacy benefits contract.
TruAudit™ is the Truveris retrospective pharmacy claims auditing solution for employer groups and benefits brokers that identifies pharmacy benefit contract errors and provides clients with details needed to pursue recovery. The solution uses a proprietary claim re-adjudication system to evaluate 100% of pharmacy claims to ensure they adhere to specific contract guarantees and logic. TruAudit™ validates the accuracy of each contract’s financial, rebate, benefit design, clinical, and EGWP compliance elements, among other guarantees, while satisfying Sarbanes-Oxley requirements of due-diligence for a plan sponsor.
“The pharmacy benefits process is complicated. Working with PBMs can be difficult and time consuming for HR and Benefit teams. Reviewing PBM performance should be conducted at least once during each contract term,” said Chief Pharmacy Officer Alysha Fluno, Pharm.D. “TruAudit™ is a natural extension of our industry leading solutions helping our clients achieve greater levels of transparency,” commented Fluno.
TruAudit™ capabilities include comprehensive support for the full life cycle of the PBM contract. TruAudit™ compliments and expands the offerings of TruGuard®. Clients using TruGuard® may experience substantial findings through an audit with TruAudit™, including plan design, rebates, or financial audits and more. Although the TruAudit™ solution now offers various auditing capabilities, below are most frequently used audits among them:
- Financial Audits: TruAudit™ Financial Audits verify the accuracy of discounted drug costs, dispensing fees, specialty pricing, AWP validation, duplicate claims, and U&C pricing compared to a plan sponsor’s PBM contract
- Benefit Design Audits: TruAudit™ Benefit Audits allows plan sponsors to verify accurate processing of the plan design across all claims
- Clinical Audits: TruAudit™ Clinical Audits validate clinical exclusions, prior authorizations, quantity limits, and step therapy edits
- Rebate Audits: TruAudit™ Rebate Audits validate the pass-through accuracy of manufacturer rebates, verifying that rebate rates reflect a plan sponsor’s formulary and benefit design. It also ensures that the PBM has included all rebate-eligible claims in the rebate calculations
- EGWP Audits: TruAudit™ EGWP Audits look at a plan sponsor’s Employer Group Waiver Plan details for accuracy in items such as drug discounts, dispensing fees, and administrative fees along with also reviewing the EGWP subsidies, Direct and Indirect Remuneration (DIR), member True Out-of-Pocket (TrOOP) accumulation, and Federal Reinsurance
This expansion of Truveris’ capabilities allows the company to provide an additional level of transparency to pharmacy benefit transactions, further helping employers and benefits professionals best manage their benefit plans.
Truveris brings transparency to the prescription drug ecosystem through data-driven innovations. Truveris’ platform offers clients – from the individual patient to employers, retailers, pharmacy benefits stakeholders, and manufacturers – the data and insights they need to effectively and efficiently manage rising costs and market access challenges. Visit www.truveris.com to learn more.
Lauren Wint, Truveris, Inc., firstname.lastname@example.org
Ben Shannon, Burson, Cohn & Wolfe for Truveris, email@example.com