Services

Pharmacy Benefit Management Compliance Services

Pharmacy Benefit Management Compliance Services

ER is the premier vendor providing pharmacy benefit manager (PBM) compliance services for regulators. Our PBM Team tailors PBM analyses and examinations to our clients’ unique needs, helping to create PBM examination standards, leading PBM examinations, and enforcing PBM transparency and fair business practices requirements. Our PBM Team actively develops and presents PBM-specific trainings to regulators on current PBM compliance issues, industry trends, and legislative and regulatory developments.

ER has completed examinations covering various aspects of PBM and pharmacy benefits over the past 12 years on behalf of state and federal regulators. ER’s PBM Team includes PBM specialists, market conduct and financial examiners, licensed pharmacists, IT/cybersecurity specialists, and diverse staff experienced in all aspects of auditing PBMs. Members of the PBM Team, including specialty sub-contractors, hold various professional designations which demonstrate the necessary skills and experience needed to assist regulators with the development of PBM examination processes and to efficiently and effectively conduct PBM examinations. This includes the Certified Pharmacy Benefit Specialist (CPBS) designation, setting our team apart as PBM compliance leaders.

Proven areas of PBM expertise include:

  • Contract review
  • Prescription drug pricing arrangements (including spread pricing)
  • Manufacturer rebate service agreements
  • Manufacturer revenue calculations
  • Reports and filings
  • Pharmacy audits
  • Complaints and appeals
  • Pharmacy network adequacy
  • Prescription drug claim transactions
  • Prescription drug utilization management services
  • Corporate governance
  • Risk management
  • Licensure and renewal documentation
  • Federal and state law mandates
  • IT/Cybersecurity
  • Market reforms requirements of Title XXVII of the Public Health Service Act (PHSA) and the Mental Health Parity and Addiction Equity Act (MHPAEA)
  • Applicable NAIC Market Regulation Handbook standards

 

Team Leadership

Craig Moore, CFE, CPBS, CPA
Director

Whitney Ederer, JD, MPH, CIE, FAHM, MCM
Manager

TESTIMONIALS

What our team says about us

Cynthia M. Fitzgerald, AIRC, ACS, AIAA, CICSR, CFE(Fraud), CIE, MCM, PHAM, ITP, CCP

Director

Working at ER has allowed me to develop my leadership skills to elevate my team in the Health Consulting Services space. Consistent and meaningful engagement with executive leadership at ER is incredibly supportive and collaborative. At ER, we foster a creative work environment where everyone feels valued and heard. ER leadership is committed to professional development and work life balance. I enjoy the opportunity to lead a strong team with vision and purpose as we support state and federal regulators with dynamic and creative solutions. One of the attributes I like most about working at ER is the opportunity to work closely with other leaders in other areas of insurance regulation. This opportunity is only possible when leaders feel trusted, supported and equipped with the tools necessary to be successful. At ER, we take care of our clients, our team and each other as we deliver on our mission.

Craig Leonard, CIE, CPCU, CCP, FLMI, ARC, AIAF, ARM, MCM

 Senior Director Market Conduct

Working at ER has been an incredible experience that allows me to lean into my strongest skills as a thought leader who is always looking to raise the bar and find better ways to improve market regulation processes. ER’s commitment to quality, efficiency, and first-rate representation creates an environment where innovation thrives, and continuous improvement is the standard. Our firm’s streamlined structure ensures prompt attention to clients at all levels, enabling me to partner with them in meaningful ways and consistently exceed their expectations. In my 34 years being involved in market regulation, I have never worked with a more knowledgeable, dedicated team. With deep knowledge and dedication to the NAIC’s Market Regulation Handbook, combined with our ‘out-of-the-box’ thinking, we identify critical findings often overlooked by others. I take immense pride in the work we do and the value we provide to our clients every day. 

Mark Ossi, CPA, CFE, AMCM, CFE (Fraud)

Director Financial Analysis

In my previous position as a state regulator, ER was one of our trusted contracting firms.  I felt like they were a strategic partner in the Department’s insurance regulatory oversight and was happy to have them be part of our team for the seventeen years I was employed at the Georgia Department.  In 2019, I joined the ER Team and have been even more impressed with ER’s professionalism, culture and commitment to assisting our client’s mission of regulatory oversight of the insurance industry with the goal of safeguarding policyholders.

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Atlanta, GA 30309-6197

Office: 404.816.6188
Fax: 404.816.6197

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South Jordan, UT 84095

Office: 801.562.5748

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Fax: 404.816.6197