Services we offer
Ridge Consulting & Audit Group, LLC (RCA) offers specialized audit services tailored for self-funded health plans seeking transparency, compliance, and cost containment in their pharmacy benefit programs. Our audits uncover financial leakages, identify contractual adherence issues, and provide actionable insights that protect plan assets and improve overall pharmacy spend efficiency. What plan sponsors fail to know can be the subject of claims for damages.
Claims Audit
Evaluate 100% of adjudicated claims for accuracy, pricing compliance, and benefit design adherence.
Specialty Drug Review
Analyze high-cost specialty claims, site of care, and PBM markup practices.
Rebate Audit
Validate full passthrough of manufacturer rebates and compliance with rebate guarantees.
Formulary & Utilization Review
Assess alignment of formulary design with clinical and financial goals.
Contract Audit
Assess PBM contract terms and alignment with operational execution and pricing promises.
MAC Pricing & Spread Analysis
Detect PBM spread pricing and validate MAC list consistency.
Contact us
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