Case Study: a large national pharmacy benefit manager achieves compliant virtual audits and revenue recovery with EXL

Innovation during pandemic results in successful virtual pharmacy audit program

A large national pharmacy benefit manager faced significant challenges in conducting essential pharmacy audits due to COVID-19 restrictions, which limited on-site visits and auditor travel. They turned to their vendor, EXL, for a solution to maintain compliance and identify overpayments.

EXL developed and implemented a successful virtual pharmacy auditing process, followed by their proprietary Prescription Verification Review program. This hybrid approach not only satisfied all audit requirements but also increased findings per audit. The solution delivered an ROI of over 80% for the client, who consequently increased their audit volume by 28.5% the following year based on these results.