Your PBM contract has a right to audit in it. Here is what happens when AI uses it.
You run a company with a few thousand employees. Drug spend is up, the broker says the contract is competitive, the PBM's own reports show it meeting its guarantees, and no one has ever checked. Under ERISA, the plan's fiduciaries are responsible for checking anyway.
What OwedRx does
It reads your PBM contract, turns every term into a rule, and re-prices every prescription claim your plan paid under those rules. Where the price, the rebate, the fee or the program doesn't match what was signed, it documents the difference down to the clause and the claim, sends the PBM a demand in the form your contract requires, and carries it through to the credit.
What it finds
Discounts below the guarantee. Rebates promised per claim and never paid. Service penalties written into the contract and never invoiced. Prior authorization and specialty rules you pay for that were never applied. People who left the company months ago and were still being paid for.
Published audits of other plans show what an audit finds when someone finally looks. Read them, with their sources.
What it costs
Pricing is set per engagement after the free review, based on what your contract allows.
What you get
A report your CFO and benefits committee can read in twenty minutes. A recovery plan sequenced to your contract's dispute window. A fiduciary file your counsel can hand to the Department of Labor, pinned to the exact contract, rules and data it used.
Your broker
We work behind your broker or consultant, not around them. They keep the relationship; we sign the findings. Under the disclosure rules you will see exactly what we're paid and by whom, which is you.
How it starts
Sign the NDA and business associate agreement we send, then send the contract and the claims file your TPA already has. No notice to your PBM, no use of your audit right. About three weeks to a number.
Questions
Does the free review use our audit right?
No. The free review runs on data your plan already holds: the claims file your TPA or data warehouse keeps and the reports your PBM has already sent you. Nothing goes to the PBM, and the review is not run as an audit under your contract. Your right to audit stays in reserve for the formal audit, timed to the window your contract allows.
What decides the terms?
Two things: the rules for employer plans, and your PBM contract. Public plans, Taft-Hartley funds and employer plans follow different rules on how an auditor may be paid, and many PBM contracts add auditor terms of their own. The free review reads your contract's audit clause and tells you which rules apply. Terms are then set per engagement and written into the engagement letter. No PBM, pharmacy, manufacturer or broker pays us anything.
Will our PBM accept you as auditor?
Your contract decides, so we check it first. Many PBM contracts say how often a plan may audit, with how much notice, in which months, how far back, and who may audit; some let the PBM approve the firm or require the auditor to sign its confidentiality terms. The free review reads those clauses and tells you, with the clause cited, whether we qualify and when the earliest window opens. We do not take on an audit your contract does not let us run. When a PBM asks, we give it a statement of our independence, our method and our insurance.
What do you need from us?
To start the free review: the NDA and business associate agreement we send, signed; your PBM contract with every amendment and pricing exhibit; and last plan year's claims file, which your TPA or data warehouse already has. If they are to hand, the PBM's reconciliation reports, rebate statements and invoices, and your eligibility file help us tie the totals. No claim data goes through this website; we send a secure link. For the audit itself: one signed envelope and your approval of the letter. We request everything else and report to your inbox.
Where does our data live?
In our US cloud, under the business associate agreement you sign before any file moves. Everything your plan sends sits under its own encryption key, and no other plan's audit can reach it. Member identifiers are hashed on arrival. No one on our side has standing access to plan data; emergency access is time-limited and logged. The record of your audit is sealed where it cannot be changed, and the file is yours to keep whether or not you keep us.