Pharmacy Audit & Recovery Solutions

● Typical Recovery = 3-4% of total spend

● Contingency Fee Based

● Free Analysis on 12 months of data

5.00%

7.00%

9.00%

11.00%

13.00%

15.00%

Pharmacy Medical

Annual Average Increase

In Healthcare Spending

2001 - 2014

5.00%

7.00%

9.00%

11.00%

13.00%

15.00%

Pharmacy Medical

One-Year Increase in

Healthcare Spending

2014 - 2015

The Problem is the Rising Cost

of Prescription Benefits

*2015 Milliman Medical Index

Pharmacy inflation is at its HIGHEST point in history

Information needed for audit on page 2.

Next Step, Free Analysis…

● Typical On-Going Savings of 15-30%

1. Client Name (Employer)2. Group ID3. Patient Identification number4. Relationship Code5. Person Code6. Date of Birth/Age Indicator7. Date Filled8. Rx Number and/or Claim Number (Transaction Code)9. Drug Name, strength & dosage form10. NDC11. Unit of measure12. DAW code13. Specialty, brand or generic- Drug Indicator (generic flag)14. Quantity dispensed15. Day’s Supply16. New/Refill indicator17. Physician name and/or NPI number

Next Step – Information Needed for Audit

FREE 12 MONTH ANALYSISRETROSPECTIVE AUDIT & RECOVERY UP TO 3 YEARS

PBM DATA NEEDED FOR INITIAL CLIENT ANALYSISPBM - Prescription data should not contain Protected Health Information (PHI)

GET STARTED NOW

www.relevanthealthcare.com855-328-5100

18. Member Co-Pay amount19. Employer paid amount20. Dispensing Fee21. Total Paid amount (copay + company pay)22. Formulary or Non-Formulary/Tier identifier23. Sales Tax (if applicable)24. Pharmacy Provider Name or NPI number25. Mail & Retail indicator26. Pharmacy Usual & Customary Price27. Ingredient Cost Submitted28. Basis of Cost: AWP, AMP, MAC unit price29. Prescription/Service Reference Number Qualifier*30. Other Coverage Code*31. Prior Authorization Number*32. Reason for Service Code*33. Personal Service Code*34. Result of Service Code*

Scott Fuqua708-390-3885

sfuqua@relevanthealthcare.com

*Optional