Why Are There So Many Audits?
Many pharmacies that PAAS National® assists with audits have similar sentiments, “Why us?” or “We just had an audit with [insert PBM here]”. It can feel like it is a never-ending cycle, with shifting standards depending on which PBM is conducting the audit. At PAAS, we understand these concerns — and we’re here to help.
To support pharmacies in managing and minimizing audit risk, the PAAS portal includes a valuable resource under the “Proactive Tips”, called Audit Flags. This resource can help pharmacies identify characteristics of prescriptions that frequently trigger audits and provide insight into why they’re being flagged. While high-cost medications are commonly targeted, there are many other lesser-known reasons a claim might attract attention. For example, did you know…
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that PBMs may analyze the geographical distance between the patient, prescriber, and pharmacy?
Additionally, the PAAS Self-Audit Article Series compliments this tool by offering actionable strategies to help reduce audit exposure. This series highlights different types of prescriptions that have historically led to PBM audits or recoupments and shares guidance to ensure your documentation and dispensing practices can withstand scrutiny. The series includes 12 different topics, each with links to relevant Newsline articles and additional resources for deeper learning.
Let PAAS help you stay ahead — with proactive tools and expert insights to protect your pharmacy. Access the additional resources available on the PAAS portal to better understand and manage audit risks. For additional support or questions, feel free to reach out to the PAAS team.
PAAS Tips:
- Review Audit Flags to identify possible audit triggers that may be occurring in your pharmacy
- Read the March 2025 Newsline article, When the Margins Are Thin, Self-Audit for the Win for information on self-audit tips and links to PAAS resources on the portal
Be prepared and confident BEFORE you receive an audit notice by reviewing the Self-Audit Article Series
- Why Are There So Many Audits? - August 6, 2025
- Manufacturer Coupons: Why It’s Important to Read the Fine Print - July 25, 2025
- Fraudulent Prior Authorization Submissions Costs Pharmacy Over $1 Million - July 23, 2025
