Tiber Creek Rx
Leading Technology
Tiber Creek Rx has leveraged our information technology resources with our superior industry expertise to create efficiencies in the audit process, shortening the length of time needed to complete an audit and get results. We can manage data sets of any size and format, and our audit process includes a review of every unique claim record. Tiber Creek Rx’s audit services fulfill all Medicare plan sponsor audit obligations, and we comply with all HIPAA requirements, including the newest HITECH standards, to ensure the confidentiality of Protected Health Information.
Experience
- Hundreds of Pharmacy Benefit Management (PBM) audits conducted, including claim pricing, benefit implementation, pharmaceutical manufacturer rebate audits and Medicare Part D regulation compliance.
- All team members have extensive PBM backgrounds.
- Unsurpassed experience analyzing and investigating pharmacy claims data.
Integrity
- Unbiased audit approach produces valid and recoverable findings.
- No conflicting consulting services are offered, in compliance with Sarbanes-Oxley auditor independence standards.
- No fees based on contingencies or percent of recoveries.
Results
- Accurate and fair assessment of PBM performance and a plan to correct any deficiencies.
- Efficient audit process leads to shortened audit timeframe and produces results.
- Advanced technological resources ensuring data security, confidentiality of PHI and compliance with HITECH standards.
Tiber Creek Rx specializes in auditing PBMs for clients of all sizes and types.
Our team has extensive experience working with:
- Independent health plans
- Third-Party Administrators (TPAs)
- Workers compensation plans
- Medicaid Advantage, Part D, and SNP plans
- BCBS plans
- Coalitions
- Employer groups
- Managed Medicaid plans
- Labor unions/Taft-Hartley funds
- Retirement funds
Unbiased Philosophy
Tiber Creek Rx approaches the audit process from an unbiased perspective. Sarbanes-Oxley auditor independence standards restrict auditing firms from providing non-audit consulting services for the same clients. Tiber Creek Rx adheres to these standards as we do not provide conflicting consulting services, such as PBM sourcing (RFPs for PBM services). Many consulting firms offering PBM sourcing services are paid fees by the PBMs their clients select. We do not need to generate additional business for a consulting division.
Our objectives remain focused on quality audit results rather than our compensation. Therefore, our fees are never based on contingencies, eliminating any unsupportable and unrecoverable findings that drag-out the audit time-frame and frustrate both our clients and the PBMs.
The Process
Our audit process was developed based on the lessons learned over nine years of auditing PBMs. The approach is engineered to make the process clear and focused, eliminating wasted time for all parties. Tiber Creek Rx works with each client to develop an agreed upon audit scope and time-frame. We tailor the audit to meet the unique needs of each client.
Obtaining accurate information and data is essential to producing a quality audit result. Our auditors do not work in a vacuum; they engage the client and the PBM throughout the process to ensure correct parameters are applied and tested.
PBM Compliance Auditing
Tiber Creek Rx’s audit services include:
- PBM Contract Pricing Audits
- Audit of PBM Benefit Design Implementation
- Pharmaceutical Manufacturer Rebate Audits
- Medicare Part C and D Plan PBM Contract Compliance Audits
- Audit of Medicare Sponsor Requirements Delegated to the PBM
- Retiree Drug Subsidy Program Audits
Pharmacy Claim Analytics
Tiber Creek Rx’s pharmacy claim analytics services include:
- Worksite Pharmacy Support Services
- Medicare Formulary Compliance Reviews including Claim Reject Verification
- Fraud, Waste and Abuse Monitoring
- Pricing and Benefit Design Modeling
- Clinical Data Mining
- 340B Pricing Verification
The Case for Auditing Your PBM
One small, honest mistake in implementing pharmacy benefits can quickly lead to your plan and members incurring substantial overcharges. Click to read our white paper on why you should audit your PBM.
Contact Tiber Creek Consulting
Contact Tiber Creek Consulting for a complimentary assessment of your existing infrastructure, and discover how we can help deploy solutions. Please inquire about other pharmacy program analytical services. Tiber creek Rx can help you in all areas where you need pharmacy claims data expertise.
Industry Publications
Pharmacy Benefits
Pharmacy Benefits: Plan Design and Management
Pharmacy Benefits: Plan Design and Management is a must-have guide for benefits professionals and trustees responsible for a prescription pharmacy or medical benefits program. Addresses benefit plan design, the selection of a pharmacy benefits manager and pharmacy network, compliance, specialty pharmacy, cost-saving strategies and more.
Pharmaceuticals have become an integral component of medical treatment, with some medications completely transforming health care outcomes and delivery. When was the last time you examined the prescription drug component of your health care benefits?
About the Author
F. Randy Vogenberg, R.Ph., Ph.D., is a principal with the Institute for Integrated Healthcare in Sharon, Massachusetts, and a former national health benefits thought leader with Aon Consulting. Since 1981, he has consulted on economic issues for pharmaceutical services, drug benefit strategy and decision making for drug therapy selection with government and employer clients.