PillarRx was recently awarded a five-year contract renewal. This renewal was based on previously implemented pharmacy benefit program recommendations, resulting in cost-savings opportunities.
An example of how PillarRx’s audit methodology and the importance of utilizing 100% of pharmacy claims was evident during one of the annual audits. PillarRx was able to identify a very small subset of claims with inappropriate adjudication of Dispense as Written (DAW) penalties. This resulted in a $700,000 recovery for the plan, ensuring the membership was contributing the appropriate cost share. Rebate audit analysis found an additional $400,000 owed back to the client. Due to the small number of claims impacted (less than .5% of claims), it is statistically improbable random sampling would have yielded these findings and over $1,000,000 recovery.