Pharmacy Oversight. Better Decisions.
We help employers independently review their pharmacy benefit spending, PBM contract performance, rebates, fees, utilization, and reporting so they can better understand where their pharmacy dollars are going and identify areas that may require further oversight.
Your pharmacy benefit deserves more than an automated review.
Every Sandia Rx audit is conducted and analyzed by a pharmacist auditor with experience in pharmacy operations, business, and financial analysis. We review 100% of the claim lines provided rather than relying on a random sample. Findings and recommendations are developed through clinical, operational, and financial review, not automated AI decision-making.
Pharmacists Review
Pharmacists review the medications, claims, utilization patterns, formulary decisions, and clinical factors behind pharmacy spend.
Financial Analysis
We examine PBM pricing, rebates, fees, guarantees, contract terms, and other financial factors that affect what the plan pays.
Human Judgement
Audit findings are evaluated by professionals who can question unusual patterns, investigate context, and determine what deserves a closer look.
Independent Findings
Our conclusions are based on the employer’s data, contract terms, and pharmacy benefit performance. The final recommendations come from our review, not an automated model.
Pharmacy benefit audits that go beyond the numbers.
Pharmacy costs are driven by more than price alone. Our audits are led by pharmacists with financial and business experience who understand the medications, utilization patterns, formulary decisions, and contract terms behind plan spend.
The Audit
A focused review of the areas where pharmacy benefit costs, PBM terms, and reporting deserve a closer look.
Drug Spend & Utilization
We review the medications driving plan spend, including high-cost drugs, therapeutic categories, prescribing patterns, utilization trends, and potential areas for deeper clinical review.
Formulary Review
We examine formulary placement, brand and generic utilization, specialty medications, therapeutic alternatives, and other drug-level factors that may influence plan costs.
Contract & Reporting Review
We compare key PBM contract provisions with available claims, utilization, rebate, and financial reporting to identify inconsistencies or areas that warrant further investigation.
PBM Pricing, Rebates & Fees
We review pricing arrangements, rebates, administrative fees, guarantees, pass-through terms, and other financial components of the PBM relationship.
A pharmacy benefit audit should understand the drugs, not just the dollars.
Traditional financial reviews can examine costs, fees, and contract terms. Sandia Rx goes further by bringing pharmacists into the audit process. We review the medications behind the spending, including utilization, formulary placement, specialty drug costs, therapeutic alternatives, and other clinical factors that may affect the plan.
Questions employers should be asking about their pharmacy benefit.
Are we paying what our PBM contract says we should be paying?
We review contract terms, pricing guarantees, fees, claims data, and available reporting to identify areas where actual pharmacy costs may not align with the employer’s expectations or contract terms.
Are rebates and other pharmacy dollars being handled correctly?
We examine rebate provisions, pass-through arrangements, administrative fees, and related reporting to help employers better understand how pharmacy-related payments flow through their PBM arrangement.
Are you overpaying for common medications?
We compare what the plan paid for common medications against national drug acquisition cost data, including NADAC benchmarks where appropriate, to identify claims that appear materially higher than expected and deserve further review.
Why use a pharmacist-led pharmacy benefit audit?
Pharmacy spending cannot always be understood from financial records alone. Our audits combine pharmacy knowledge with financial experience to evaluate both the dollars being spent and the medications, utilization, and clinical factors behind those costs.
What medications are actually driving our pharmacy costs?
Our pharmacist-led review looks beyond total spend to examine high-cost medications, specialty drugs, therapeutic categories, utilization patterns, formulary placement, and other drug-level factors affecting plan costs.
