PBM Audits & Defense
Network audits, recoupments, terminations, and appeals against Caremark, OptumRx, Express Scripts, and other PBMs.
How PBM Audit Findings Escalate to Network Termination
How a PBM audit finding becomes a termination for cause notice, the short appeal window that follows, and the risk of cross-networ…
Navitus Audits: What Pharmacies Should Know
Navitus Health Solutions audits pharmacies through desk and on-site reviews with strict deadlines. Here is how pharmacies should r…
Humana Pharmacy Audits: What to Expect and How to Respond
A guide to Humana Pharmacy Solutions audit formats, the documentation requested, common discrepancy findings, and the appeal windo…
MedImpact Audit Findings: How Pharmacies Respond
How MedImpact conducts desk and onsite pharmacy audits, the documentation standards it applies, and how a pharmacy should respond…
CVS Caremark Audit Appeals: Deadlines and Procedural Defenses
How the Caremark audit appeal process works, the state notice and deadline floors that apply, and the procedural defects that can…
OptumRx Audit Defense: What Pharmacies Should Expect
OptumRx audits move on strict deadlines and extrapolated demands. Here is what pharmacies should expect, from audit type through t…
What a PBM Audit Really Costs: Extrapolation and Recoupment Explained
The claims named in a PBM audit notice are rarely the real exposure. How sampling and extrapolation turn a small finding into a de…
GLP-1 PBM Audits in 2026: The Enforcement Playbook
GLP-1 claims are the leading PBM audit target of 2026. What OptumRx, Caremark, and Express Scripts flag, and how pharmacies defend…
How to Respond to a PBM Audit Letter
A PBM audit letter starts a recoupment clock. What a pharmacy does in the first days shapes the demand, the appeal, and whether on…