Read the definitions first
Identify pricing guarantees, exclusions, rebate provisions, dispensing terms, specialty arrangements, and reconciliation rules in the actual agreement.
Plan sponsors, benefits leaders & advisors
Put pharmacy spending beside the agreement.
Make the differences visible.
A pharmacy benefit agreement can contain pricing and rebate definitions that are difficult to validate from a summary report alone.
Start with a business question. No records or commitment required.
FROM THE QUESTION TO THE EVIDENCE
What belongs in the review.
Match the supporting records
Determine what claims, rebate, and reconciliation data are available for the agreed period. Audit rights, data completeness, and consistent definitions shape what can be tested.
Validate any difference
Compare performance with the applicable contract terms, document exceptions, and clarify the response process. A modeled variance is not a finding or a promised recovery.
MAKE THE FIRST STEP SPECIFIC
What would make this worth examining?
A high-level summary is enough to begin. The team can help clarify the question before requesting detailed information.
- Which guarantee or pharmacy cost needs clarification?
- What audit rights and data access does the agreement provide?
- Who can reconcile claims and rebate records for the review period?
YOUR ASSUMPTIONS · TRANSPARENT MATH
Explore a scenario.
See what a percentage would mean for a defined review amount. You supply both inputs; this tool does not predict a finding or determine eligibility.
ILLUSTRATIVE DIFFERENCEAdd your assumptions
No recovery percentage is supplied or endorsed by BC Group.
This is arithmetic, before any fees or collection costs. It is not an audit result, a recovery forecast, or a percentage of total annual revenue.
Inputs stay on this page and are not submitted.BEFORE YOU CONTINUE
A few useful answers.
Does this require changing our PBM?
The review starts with the existing arrangement. A finding can support clarification, reconciliation, or a later comparison; it does not itself require a provider change.
Should we upload claims here?
No. Begin with the business concern and high-level scope. Contracts, pharmacy claims, and sensitive records should follow only through an agreed secure review process.
YOUR SITUATION SETS THE SCOPE
Let’s start with what matters to you.
Tell David what prompted the question, what needs to keep working, and any timing that matters.