Audits, Billing, Compliance – The ABCs of PBM Billing

Ignorance is not bliss when it comes to PBMs

Effectively handling audits, billing correctly and being confident in your compliance is a great place to be and it is where you will find yourself after spending a couple days with Chris and Mark of Pharmacy Compliance Consulting.

You’ll hear real-world examples that resonate to everyone in independent pharmacy today.

Attendees will learn:

  • The do‘s and don’ts of your most important PBM contracts so you can confidently bill prescriptions
  • How to avoid the common traps that await you in PBM contracts
  • Your rights during an audit and how to properly handle an audit when you receive one

Audit, Billing, Compliance Training Sessions

Updated Class Schedule Coming Soon

Spring 2019

March 15-16, 2019 / Austin, TX

Spring 2019

April 10-11, 2019 / Durham, NC

Who Should Attend Audit, Billing, Compliance Training?

  • Pharmacy Owners
  • Pharmacy Managers
  • Key Billing Employees

ABCs of PBM Billing is available exclusively to PDS members.

Pricing For Audit, Billing, Compliance

  • $750 Elite & Premier Members
  • $1,500 Member List Price


We have all been through audits before. What if you had some inside knowledge about how to prepare effectively, know what the auditors are looking for and even have a checklist to make sure you are prepared for that desk audit or onsite audit?

You need a team on your side who have the experience and knowledge to explain to you how to be prepared and the most common pitfalls. Enter the Pharmacy Compliance Consulting team of Chris Gruber and Mark Newkirk. As pharmacists and former PBM auditors they are putting their experience to work for you.

As one PDS member put it, “Every PDS member would benefit from this course and I will attend every year or two to brush up.” – Jim Cherry, PDS Member

It is critical in today’s environment that every pharmacy owner take the first step in audit preparation and readiness by attending this course.


Billing a claim to an insurance is pretty easy work. With a few pushes of some buttons you can send a claim and get a response in a matter of seconds. If that is your staff’s understanding of the billing process, you and your pharmacy are at risk. Billing is so much more complicated than inputting the information onto a screen.

Educate yourself and your staff on the rules in each contract to be better prepared for when you receive an audit. Give your team the confidence that they are billing correctly every day leaving you empowered that you can handle your next audit.

Invest in yourself and invest in your team. Pharmacy owners, billing managers and other key employees will benefit immensely from the ABCs of PBM Billing.


Understanding the entire PBM manual is next to impossible. CVS’s latest manual is 345 pages long while Express Scripts is 121 pages and OptumRx’s is 160 pages. Therefore, this jam-packed day and a half will take a deep dive of CVS, ESI, OptumRx and Prime Therapeutics contractual and manual language of the key sections that mean the most to your pharmacy.

Once you understand the key points of your PBM manuals you will be able to go back to your pharmacy, develop a process for your team to be consistently compliant.

What attendees are saying about ABCs of PBM Billing

“Every PDS member would benefit from this course and I will attend every year or two to brush up.”

“Call Chris and Mark at Pharmacy Compliance Consulting. They have always given us great audit advice not cookie cutter strategies like the other companies. It’s worth every penny.”

Top Benefits

  • Learn information to help with audits, current or in the future

  • Each contract is unique and the differences are important to understand

  • Give your employees the confidence they need to thrive in their roles

  • No longer feel powerless when dealing with PBMs

Growth Impact

  • Keep more of your high-profit earnings by remaining in compliance with your contracts

  • Confidently bill high margin prescriptions, knowing you are in compliance

  • Keep your contracts by avoiding risky billing behaviors

Download our Program Sheet for more Info

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Our comprehensive suite of courses will address all your training and team development needs from leadership to technician training. PDS also has developed a full offering of pharmacy specific niche program trainings that are sure to benefit your patients and to increase your profits.