PBM Audit Summary Report Template CY 2026 - Pharmacy Benefit Manager Audit Summary Report Template

Sep 2, 2026

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Pharmacy Benefit Manager audit summary report template for calendar year 2026 sets requirements for coordinated care organizations to obtain and submit a neutral third-party compliance audit. The audit must verify pharmacy payments follow PBM subcontract terms and confirm manufacturer rebates and other payments are passed through as described in the contract. The CCO must use the OHA-provided template to submit an executive summary and action synopsis to OHA via Administrative Notice within seven business days of receiving the audit report, with the audit delivered by July 1, 2026.

LanguageEnglish

CategoryForms

FormatDOCX

Pages4

Reading Time2 min

AccessFree to download

Audit Summary Report Template Requirements

Purpose and Scope of the PBM Audit

Instructions for Completing and Submitting the Template

Due Dates and Submission Channels

Technical Assistance and Support Contact

Pharmacy Benefit ManagerAudit Summary ReportTemplate Effective: January 1, 2026 Background: If a Coordinated Care Organization (CCO) contracts with a Pharmacy Benefit Manager (PBM) other than the Oregon Prescription Drug Program (OPDP), then the CCO must require its PBM to fully cooperate with a CCO-directed annual third-party audit. The CCO must use a template provided by OHA to submit the executive summary of the audit findings as specified in Exh. B, Pt. 2, Sec. 7, Para. e, Sub.Para. (2) (d) of the 2026 CCO contract and excerpted below: “(d) Fully participate and cooperate in the annual audit of compliance with the terms and conditions of the PBM contract between Contractor and the PBM. Participation and cooperation by Contractor shall be subject to the direction of the auditor. “i. The annual compliance audit must be performed by a neutral, unaffiliated third-party and be completed and delivered to Contractor by July 1 of each Contract Year; “ii. The audit must include, without limitation, a determination as to whether pharmacies were paid in accordance with the terms and conditions of the PBM Subcontract and a determination that all rebates and other payments made by manufacturers to the PBM or its Affiliates were passed through as described in this Contract, including, without limitation those provisions found in Sec.16 of Ex. B, Part 8. “iii. Contractor shall submit to OHA, via Administrative Notice, an executive summary of the annual PBM Subcontract compliance audit findings and a synopsis of any actions Contractor took as a result of the audit findings. Contractor shall use the template provided by OHA on the CCO Contract Forms Website. Contractor shall submit the executive summary of the audit report to OHA, via Administrative Notice, within seven (7) Business Days of Contractor’s receipt of the audit report.” Purpose: The purpose of the PBM audit is to ensure the PBM is compliant with contractual requirements, including the requirement to appropriately pay pharmacies and pass through rebates as described in contracts. Instructions: The CCO shall use the information from the PBM audit to complete the Pharmacy Benefit Manager Audit Summary Report Template. The Template contains the requirements described above. The Pharmacy Benefit Manager Audit Summary Report template is located on the CCO Contract Forms webpage at: HYPERLINK "https://www.oregon.gov/oha/HSD/OHP/Pages/CCO-Contract-Forms.aspx" https://www.oregon.gov/oha/HSD/OHP/Pages/CCO-Contract-Forms.aspx . Due Date: A third-party audit must be completed and delivered to the CCO by July 1, 2026. The CCO must submit a completed Pharmacy Benefit Manager Market Check Summary Report to OHA within seven (7) days of receiving the market check from the third-party evaluator. The CCO must submit the completed form via the Contract Deliverables portal located at HYPERLINK "https://oha-cco.powerappsportals.us/" https://oha-cco.powerappsportals.us/. (The submitter must have an OHA account to access the portal.) Technical Assistance: OHA is available for technical assistance prior to submission of the Attestation. The CCO should contact OHA for assistance as early as possible. The due date for the Audit Summary Report will not be extended because the CCO is awaiting assistance. Please email all technical assistance requests to HYPERLINK "mailto:CCO.MCODeliverableReports@odhsoha.oregon.gov" CCO.MCODeliverableReports@odhsoha.oregon.gov . Effective: January 1, 2026

FAQs

What is the purpose of the PBM audit summary report?

To ensure the PBM complies with contractual requirements, including appropriate pharmacy payments and proper pass-through of rebates as described in the contracts.

What must the third-party compliance audit include?

It must determine whether pharmacies were paid according to the PBM subcontract terms and confirm that rebates and other manufacturer payments were passed through as required by the contract.

When must the audit be delivered and when must the CCO submit the executive summary?

The third-party audit must be completed and delivered to the CCO by July 1, 2026, and the CCO must submit the executive summary to OHA within seven business days of receiving the audit report.

Sep 2, 2026

Upload by Noah