Get Full Government Meeting Transcripts, Videos, & Alerts Forever!
Get email alerts on the Pharmacy Benefits topic
No spam. Unsubscribe anytime.
Employee benefit board approves pharmacy benefit manager audit showing few errors and rebate surplus
Summary
Gallagher auditors reported a largely favorable review of Navitus’s management of Mohave County’s pharmacy benefit for plan year July 2023–June 2024, identifying a small number of errors, a financial surplus and manufacturer rebates that exceeded contract guarantees; the board voted to accept the audit.
The Mohave County Employee Benefit Trust Board voted unanimously to accept a pharmacy benefit manager (PBM) audit of Navitus covering the July 2023–June 2024 plan year, after receiving a presentation from Gallagher auditors that found few contract errors and overall financial overperformance.
Sherry Blue, director of PBM audits at Gallagher, told the board that the audit reviewed 15,824 paid pharmacy claims representing about $2,990,586 in spend and identified an estimated 263 minor errors across the claims population. "Those errors involved minor issues with excluded products and quantity limits," Blue said. "Navitus has agreed to those errors, and we're doing some system adjustments and coding updates so that those don't occur again."
Blue said the audit reconciled claims pricing, rebates and benefit design against the contractual guarantees in Mohave County's Navitus contract and found the PBM produced a surplus overall. For rebates, Gallagher calculated a theoretical guarantee of roughly $261,000 for one channel while manufacturer rebates collected totaled about $1,000,093; because rebates collected exceeded the guarantee, the collected amount was what Navitus owed the trust. "Because this amount here is higher than the guarantee, this is the amount that they owe you," Blue said.
Board members asked how rebate money is handled. Susie Perel Duransel asked whether rebates are subtracted from other plan payments; a county staff member answered, "The rebate money comes in to the county and ends up in the trust balance." Board members also questioned the sample sizes used for certain scope items; Blue said the audit examined all claims to identify potential exceptions, then sampled potential discrepancies for documentation and reconciliation.
After questions, a trustee moved to approve the audit as presented; the motion was seconded and the board voted "ayes have it." The meeting record shows the motion passed and the audit accepted.
The audit presentation is intended to satisfy an annual contract requirement to verify Navitus’s compliance with pricing and rebate guarantees. Gallagher said it will continue to work with Navitus on coding and system adjustments to prevent the identified minor errors from recurring.
