PBM Audit Attorney

Pharmacy Benefit Manager Audit Attorney

A PBM (Pharmacy Benefit Manager) audit is a review process where an organization’s pharmacy benefit manager’s activities and practices are examined to ensure compliance with contractual obligations, regulations, and industry standards. PBMs act as intermediaries between insurers, pharmacies, and drug manufacturers to manage prescription drug benefits on behalf of health plans.

Here are the key aspects typically involved in a PBM audit:

Claims Review: Evaluating the accuracy and legitimacy of prescription claims processed by the PBM.

Contract Compliance: Ensuring the PBM adheres to the terms and conditions specified in the contract with the employer or health plan.

Rebate Management: Verifying that the PBM appropriately manages and passes through manufacturer rebates to the client.

Formulary Management: Reviewing the PBM’s formulary decisions to ensure they align with clinical guidelines and contractual agreements.

Pricing and Discounts: Checking the pricing structures, discounts, and fees applied to the prescriptions to ensure they are transparent and fair.

Network Adequacy: Assessing the network of pharmacies to ensure it meets the accessibility and coverage requirements of the contract.

Compliance with Regulations: Ensuring the PBM complies with federal and state regulations governing pharmacy benefits.

Data Integrity: Verifying the accuracy and integrity of data related to prescription drug claims and patient information.

Financial Accuracy: Confirming that financial transactions, including payments and reimbursements, are accurate and properly documented.

PBM audits are conducted to protect the interests of the clients, ensure transparency, and maintain the integrity of the pharmacy benefit management process.

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Client Testimonials

Jim Schoene

Mansoor Ansari is like a tax encyclopedia and knew more than the auditors of four states.


Hiring Ansari Tax Law Firm was easily the best decision we made as he made the process so much smoother and we ended up saving way more money than expected.


Ansari Law Firm saved me untold $1000’s if not 6 figures of dollars on an audit. This firm is the most professional firm I have ever dealt with.


Mansoor is a strong communicator. It is evident that he is an expert on taxes, regulations, and processes surrounding this complex topic. Highly recommended and will use again for any tax related questions.


Mansoor has excellent tax knowledge and consistently goes above and beyond to deliver best in class tax attorney services. Highly recommend him.


This tax firm consists of top-notch professionals who really helped me navigate tax related setup and understand my obligations as an employer of 20+ professionals. I would recommend Ansari firm to anyone without hesitation.


Excellent, Top-notch, always there to answer any and all of my questions! Would highly recommend Ansari Tax.


The service was amazing and extremely professional. Mansoor Ansari is a remarkable tax attorney and very motivated to ensure his clients questions and concerns are handled in a timely fashion. It was a pleasure working with him.

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