Third party pharmacy audits: can they be improved?

Abstract

OBJECTIVE: To discuss issues surrounding the current auditing practices associated with third party insurance prescription claim programs. DATA SOURCES: Audit examples obtained during the last 10 years associated with third party audit methodology. SUMMARY: Many unattended issues are associated with third party pharmacy audits. Some issues for discussion are presented in an attempt to produce some possible solutions for the audit inequities. CONCLUSION: National professional organizations, insurance companies, and payers need to convene and formulate fair auditing guidelines.