Pharmacy Benefit Forensics

2026 Highlights: Through June 1, 2026, we have identified and initiated resolutions with PBMs for the following problems amounting to more than $7.6M in savings and/or restitution expected, initiated investigations with the PBMs, and recaptured lost funds: An employer received their Q1 Rebate Check from their PBM. It was the highest quarterly rebate check they had ever received and their finance team was very pleased because it exceeded budgeted rebate amounts for Q1. Howeve

Below are some of the highest value savings we uncovered in 2025. An employer was part of a large GPO coalition PBM benefits plan and able to access significantly better discounts and contractual terms as compared to employers outside the GPO coalition. Upon changing GPOs to reduce overhead costs, the employer was told the new GPO did not have a coalition PBM plan and would need to seek a new PBM benefit plan on their own. We re-engaged the original PBM and found the employer

Pharmacy Benefit Forensics own Robert Schenk was asked to join a multi-disciplinary task force providing guidance to New Jersey Governor-elect Mikie Sherrill. The Governor-elect has made healthcare affordability a high priority for her new administration and Schenk will be tasked to help address PBM reform in the State, an area that has been identified as helping to drive the high cost of prescription drugs for residents.

October 14, 2023 In 2023 many employers have experienced unexpected and unbudgeted prescription benefit cost increases as much as 3 to 4...

Once again. our preventative services have proactively identified a suspicious pharmacy submitting claims for drugs we previously...

A Fair Lawn pharmacist from Mahwah admitted Wednesday that she participated in a scheme to fill bogus prescriptions for medically unnecessar

Comments by Robert Schenk: "The U.S. Government has an Inspector General to monitor its claims and still gets scammed out of Hundreds of...

By Jeff Goldman | NJ Advance Media for NJ.com Two New Jersey doctors are among four men charged with being a part of a $4.5 health care...

High Value Prescription Benefits Claims can quickly deplete your budget in broad daylight while everyone is looking.