OUR MISSION

Pharmacy Compliance Consulting exists to solve the critical issues facing our clients, both large and small. Our unique approach is not only what differentiates us, but also what makes us successful. We provide a broad range of services and solutions to help organizations facilitate change, achieve their vision and optimize performance and productivity.

About Our Business

Pharmacy Compliance Consulting

The independent retail pharmacy industry is unique in that owners must sign contracts with Pharmacy Benefit Managers in order to process claims for their insurance customers. These are take it or leave contracts. Negotiation is a myth. These contracts, written by the PBMs solely for their benefit and augmented by ever changing manuals (300+ pages), are designed to limit your ability to serve your customers, grow your business and to recover claims whenever your pharmacy poses a threat to their revenue streams.

We taught the definitive class on PBMs and audits. We know the PBM manuals and contracts inside and out. We know the state and federal laws and how to protect your business and pharmacy from abuses. We exhaust every means to protect you pre-audit and defend you if needed post-audit.

Pharmacy Compliance Consulting was formed to fight against the stacked deck retail pharmacies face every day. Pre-audit, post-audit, appeals, arbitration, litigation, contracting, credentialing, PSAOs and improving business practices/opportunities. We provide the specialized support and knowledge to fight these battles and grow your business.

Our mission is to exhaust every resource, including the PBM's own rules, to effectively fight for your pharmacy's rights and business when you are being treated unfairly. Call us today for an introduction.

Why Are We Here?

Our phones just kept ringing. Pharmacy owners who would not accept "there's nothing I can do" from their advisors, were continuing to reach out to us with their problems. We understand that pharmacies are in a fight for their very survival. That fight isn't getting any easier, especially when the rule book changes at the whim of your business partner.

Pharmacy Audit

We taught the definitive class on PBMs and audits. We know the PBM manuals and contracts inside and out. We know the state and federal laws and how to protect your business and practice from illegal abuses. We exhaust every means to protect you pre-audit and defend you if needed post-audit.

PBM Abuse

Let's face it, unless you are a cash only pharmacy, your contract with PBMs was written by the PBMs. The less money pharmacies make, the more money PBMs make. We know of no other business contract where a company has no idea what they are going to be paid on every transaction. Then PBMs want to enforce made up rules to limit your business!

Services

Pharmacy Compliance Consulting exists to solve the critical issues facing our clients, both large and small. Our unique experience is not only what differentiates us, but also what makes us successful. We provide a broad range of services and solutions to help pharmacies fight audits, facilitate change, achieve their vision and optimize performance and productivity. Whether it is one of the large PBMs or a smaller local PBM, we are here as your experts to fight on your side.

Traditional Audits

Pharmacy Compliance Consulting is a consulting company owned and operated by prior PBM auditors and insiders. We know your contracts, manuals, federal and state laws and rights as a pharmacy provider. We are here to help your pharmacy survive the audit process. From previewing claims prior to audits to formulating written appeals, we provide that expert help to make sure you are fighting the audit in the best way possible.

Contractual Assistance

With years of contracting experience, we have the capabilities and expertise to obtain contracts when you have been unsuccessful. At Pharmacy Compliance Consulting, we combine our insights, skills and contacts to go after and obtain contracts that you have been unjustly denied.

Inventory Audits

It can be a major endeavor for an independent pharmacy to reach out to all wholesalers, distributors, and suppliers where purchases have been made for drug and OTC products in the last year. This type of audit can quickly escalate to the point of the PBM pending millions of dollars from your pharmacy. Does your pharmacy have automatic or even a manual process in place to ensure you are billing for the correct NDC? Have you verified whether or not all of your vendors are licensed to sell drug products in your state of practice? If they are not licensed, are they utilizing a licensed 3PL? Do you have an efficient and accurate process to archive all invoices electronically or manually? Can you provide track and trace documentation for all product purchases and returns if requested? Can you provide proof of purchase via check, credit card, or other payment vendors? Does your pharmacy keep an accurate electronic perpetual inventory? Is your returns process an integral part of maintaining an accurate on hand inventory? We are here to help in this highly complex and dangerous audit.

PBM Litigation

Pharmacy Compliance Consulting works with law firms as experts to understand Pharmacy Benefit Managers opaque practices. When you need an understanding of what really happened, we are the experts who understand pharmacy claims processing at the root level. Why did a claim process? Was the formulary followed? Was the Prior Authorization process correctly followed? Did the claim pay according to formulary? Were state and federal laws followed? When you need the nitty-gritty inside knowledge to go up against a PBM, you need Pharmacy Compliance Consulting on your side.

Team

Get To Know Us

Christopher L. Gruber, PHARM D

Chief Operating Officer/Co-Owner

Mark Newkirk RPH, BSBA

President/Co-Owner

Contact Us

Address

2539 John Hawkins Pkwy
STE 101, PMB 207
Birmingham, AL 35244

Phone Number

+1 205-769-6992

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