PBMs can identify opportunities to recover claims, provide education or apply controls to prevent financial loss, improve safety and support claims integrity. (Photo: Shutterstock)
The National Health Care Anti-Fraud Association estimates that the U.S. health care system loses tens of billions of dollars every year to fraud, waste and abuse (FWA). A large portion of these costs are attributed to pharmacy spend, including duplicate claims, data entry errors, forged prescriptions and intentional overcharging.
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