Initial Audit
The Sandia Initial Audit gives employers an independent first look at pharmacy claims, PBM pricing, contract terms, and the medications driving pharmacy spend.
What the Initial Audit Reviews
The Initial Audit is a focused first-pass review designed to identify where pharmacy benefit costs, PBM terms, or utilization may deserve closer attention. We review the information already available to determine what the data shows and where deeper investigation may be warranted.
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We review available pharmacy claims, plan-paid amounts, fees, pricing terms, guarantees, and other financial details to understand what the employer paid and where the pharmacy dollars went.
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We examine the medications behind the spending, including specialty drugs, high-cost therapies, generics, drug mix, and utilization patterns that may be contributing to pharmacy cost.
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We compare selected claim pricing against appropriate external benchmarks to identify medications where the amount paid appears unusually high and warrants closer review.
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We review relevant contract terms, pricing guarantees, fee provisions, and other available PBM documents to identify areas that may require clarification or follow-up.
How the Initial Audit Works
Share the available information
We begin with the documents and data your organization already has available, such as pharmacy claims, PBM reports, and relevant contract terms.
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We review the benefit from multiple angles
Sandia Rx reviews the pharmacy benefit from both a financial and clinical pharmacist perspective to understand what was paid, how it was priced, and what medications are driving the spend.
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We identify what deserves attention
We look for unusual pricing, high-cost medications, specialty spending, contract questions, fee issues, and other patterns that may warrant further review.
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You receive clear findings and next steps
Material findings are translated into plain-language explanations, questions to take back to the PBM, and areas that may require additional documentation or deeper review.
Request an Initial Audit
Tell us what you would like reviewed and we’ll follow up to discuss whether an Initial Audit is the right next step.
