MPA | Pharmacy News

The COVID-19 pandemic caused PBMs to shift last year from in-person audits of pharmacies to virtual ones, adding significantly to pharmacists' workloads. Data from PAAS National, a pharmacy audit assistance service, showed the number of pharmacy audits in 2020 dropped almost 14% from the previous year. However, the overall number of prescriptions reviewed increased 40% — meaning that pharmacies had to provide more documentation and stood to lose even more money if auditors could find a reason to deny payments.

According to the PAAS data, the average audit last year cost pharmacies nearly $24,000, which is 35% higher than the annual average over the previous 5 years. In addition, the number of prescriptions reviewed in September and October 2020 was fourfold what PAAS members had seen in previous years. Pharmacists note the virtual audits increase wait times and drive up costs for customers — and the audits also cost pharmacies thousands of dollars in payments for drugs already dispensed.

"It's definitely pulling pharmacy staff away from their duties, and it's become an administrative burden, which does have a direct impact on patient safety," said Garth Reynolds, executive director of the Illinois Pharmacists Association. "They have to be the de facto audit team for the pharmacy benefit managers."

Furthermore, notes Trent Thiede, president of PAAS National, in-person audits are primarily conducted by the auditors themselves, with occasional requests for additional documentation from the pharmacists.

"In these virtual audits, you have to pull the prescription, put it through a copier of some kind, get everything aggregated, get all the signature logs. They want your license off the wall. They want all the employee licenses faxed," Thiede said. "It's a lot more laborious for these pharmacies."

Thiede and others are concerned that while in-person audits may resume after the pandemic, virtual audits may continue on, too.

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