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Pharmacy Audits in 2026: PBM, DSCSA, and the New Wave of Government Reviews

  • 74 minutes
  • 39 slides
What we'll cover
  • 0:00 Why 2026 Feels Different
  • 8:00 PBM Scrutiny Gets Sharper
  • 20:00 DSCSA Proof Must Travel
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What you'll take away

Practical shifts you can apply this week

  • Identify Likely Audit Triggers

    Spot the patterns most likely to draw PBM, DSCSA, and government scrutiny in 2026.

  • Compare Evidence Standards

    See how payer, trading-partner, and regulator reviews ask for proof in different ways.

  • Diagnose Workflow Gaps

    Find the missing links that can turn a routine review into repayment, sanctions, or referral risk.

  • Design Cross-Functional Response Process

    Build a response flow that keeps facts straight, deadlines visible, and escalation disciplined.

  • Decide 90-Day Priorities

    Leave with a short list of remediation actions to sequence first, not a sprawling cleanup plan.

Agenda

What we'll cover

  1. 0:00

    Why 2026 Feels Different

    Why PBM, DSCSA, and government pressures now intersect and make small record gaps costlier.

  2. 8:00

    PBM Scrutiny Gets Sharper

    Recoupment trends, refill and reversal patterns, and the documentation traps that shrink appeal options.

  3. 20:00

    DSCSA Proof Must Travel

    What mature traceability looks like when transaction data must move across systems and partners.

  4. 31:00

    Government Reviews Change Shape

    How records, interviews, and electronic data are tested together by CMS, MEDIC, OIG, DEA, and states.

  5. 41:00

    Documents That Decide Outcomes

    The dispense-to-claim-to-inventory chain, plus prior auth, shipping, returns, timestamps, and version control.

  6. 51:00

    Run A Clean Response

    Scope control, request tracking, cross-functional roles, and when to push back versus produce.

  7. 57:00

    Your Next 90 Days

    A practical close: run one mock audit, assign owners to the top five fixes, then open Q&A.

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