An audit your board can put on the agenda.

You run a health plan for a county, a city, a school district or a university. Prescriptions are a third of what it costs, and the contract that sets the price was written by the PBM. You have a right to audit it. Almost no plan your size ever has.

What we do

OwedRx checks every prescription claim your plan paid last year against the contract: the discounts, the fees, the rebates, the service guarantees, and the programs you pay for. We tell you what was charged in error, we send the PBM a demand for it in the form your contract requires, and we stay with you until the credit arrives.

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 written for a public meeting, with every figure traced to a contract clause and a claim. A recovery plan that tells you what to send, when, and what to hold for the next contract. A file your attorney keeps whether or not you keep us.

How it starts

With a free review of last year's claims, using data the plan already holds, with no notice to the PBM. About three weeks later you have a memo that says what an audit would find and whether it is worth running this year. If it isn't, the memo says so.

Procurement

We respond to RFPs for PBM audits with method, references and a sample report. For engagements under your threshold, scope and deliverables are defined in a two-page statement of work. Our findings are written to be read into the public record.

Questions

Does the free review use our audit right?

No. The free review runs on data the 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 public 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 the 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.