Case Study: 4M Member National Health Plan recovers $33M with Conduent Pharmacy Audit Solutions

4M Member National Health Plan recovers $33M in 3 years with Conduent

A 4M member national health plan was constrained by its internal staffing ability and needed help conducting required audits at scale to monitor its Pharmacy Benefit Manager's activity. To address this challenge, the health plan engaged vendor Conduent for its pharmacy audit solutions.

Conduent implemented a two-fold payment integrity solution aimed at controlling pharmacy costs. This approach identified 16% of claims as discrepant on average and recouped 3% of pharmacy spend, resulting in $33 million recovered for the customer over three years.