Streamline the PBM audit process with confidence

“This is a comprehensive, value-added service designed to strengthen audit readiness, reduce the risk of non-compliance, and improve audit outcomes,” says Tracie Acosta, Manager – Elevate Provider Network Quality Compliance. “We combine professional guidance with educational resources so pharmacies in our network can respond to audits more efficiently and with greater clarity.”

A built-in benefit
Pharmacies often pay third parties for audit support. Elevate Provider Network members, however, can access this audit assistance as part of their membership, making it a practical benefit to use early rather than waiting until an audit becomes urgent. 

In addition, new optional buy-up services are planned to expand what pharmacies can do proactively.

• On-site Unmasked Report: When a PBM provides a masked audit list, this service helps identify the prescription numbers tied to the list. The goal is to give pharmacies time to pull records, review documentation, and prepare in advance of the auditor’s review. The pharmacy contacts the Elevate Provider Network Audit and Compliance Team at Elevate_audits@cencora.com, receives an authorization form, submits the PBM audit list, and then receives the uncovered prescription details. Billing occurs as a one-time charge reflected in the next statement.

Support that starts before the audit begins
A key component of the program is pre-audit assistance, which focuses on preparation and risk reduction. “When a pharmacy receives an audit notice, my team can help review the notice details, talk through what the requested materials mean, and share current tips and trends being seen across audits,” Acosta explains. If the pharmacy needs help identifying key billing information (such as BIN-related details), that guidance is also part of the pre-audit conversation.

For desktop audits, where materials are submitted for review without an on-site visit, preparation becomes even more critical. In these cases, pharmacies can request support from Elevate Provider Network in reviewing prescriptions before sending them to the PBM, helping to complete the submission and align with audit expectations. This extra review step can reduce avoidable discrepancies and improve the pharmacy’s confidence in what is being sent.

Guidance after findings, and help with appeals
Audit support doesn’t end when the PBM sends results. Elevate Provider Network also provides post-audit assistance, helping pharmacies interpret and respond to findings once they receive a discrepancy letter. Pharmacies can walk through issues item-by-item, understand what was flagged, and receive suggestions for how to approach the appeal process.

To make follow-up easier, Elevate Provider Network’s members have access to appeal support tools, such as templates that pharmacies can use if documentation is needed in the form of patient or prescriber attestations. Pharmacies can also have their appeals reviewed before submission. “We look for things like language clarity, consistency, and alignment with the discrepancies being challenged,” says Acosta.

PBM outreach support (when applicable)
During an audit, pharmacies need to communicate with PBMs, including asking questions about audit requirements or requesting extensions when timelines are tight. Because of existing PBM relationships, the Elevate Provider Network team can often reach out on behalf of participating pharmacies. (Certain direct contracts may limit direct outreach in some cases; however, support for the audit itself remains available.)

Why it matters
PBM audits are unlikely to go away, but how a pharmacy responds can affect workload, outcomes, and financial risk. Elevate Provider Network Audit and Compliance Team provides structured, end-to-end support in understanding the audit notice, reviewing documentation to help pharmacies stay compliant, protect revenue, and keep their focus on patient care.

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