Independent Pharmacy Claims Monitoring & Drug-Cost Review
Drug-cost transparency, independently verified.
An independent check on what self-funded plans pay for prescription drugs.
Pollard Advisory gives self-funded health plans an independent, recurring check on what they pay for prescription drugs, verifying that a plan's actual costs match the deal it was promised, and documenting it.
16 years building drug-cost analytics · millions of pharmacy claims analyzed across 500,000+ members · PhD & MBA, Duke
The problem
When a company pays for its employees' health coverage, prescription drugs are usually the most confusing and expensive part of the bill. The middlemen who run that benefit (PBMs) work behind complicated contracts, and the employer is responsible for the spending but rarely has anyone independent checking it.
Under federal law, the people responsible for the plan must make sure those costs are reasonable, and document that they checked. Most have no independent way to do either.
And the stakes are rising. A wave of lawsuits over health-plan costs has turned prescription-drug oversight into a live fiduciary risk. Defending a claim can run into the millions, even when the plan wins. Acting on what a review finds typically moves 3% to 15% of pharmacy spend, whether that is a re-bid or a tougher renegotiation.
The regulatory picture is moving too. The FTC's proposed settlement with CVS Caremark gives self-funded plans new options on what members pay at the pharmacy counter, but only if the plan elects them.
The independent check
Pollard Advisory fills that gap. With no stake in the PBM arrangement, it reconciles a plan's real claims against the PBM's own contract guarantees and measures costs against objective public benchmarks. Every cycle it delivers a clear, documented review that nobody inside the arrangement can provide.
What the review covers
Is the PBM delivering?
The plan's actual claims reconciled against the PBM contract's own discount, rebate, and fee guarantees.
Are the costs reasonable?
Net cost measured against an objective public benchmark, with overpayment outliers flagged.
Are the required disclosures in hand?
Confirmation the plan holds the §408(b)(2)(B) compensation disclosures from its providers.
A documented fiduciary file.
A dated, independent record each cycle that proves the plan did its due diligence.
A 30-minute review call.
A walkthrough of the findings and what they mean for the plan.
Services
- Independent Claims Monitoring The recurring, unconflicted review that holds a plan's PBM to its contract each cycle and documents a prudent process.
- One-time independent review A documented read of a plan's pharmacy contract, claims, and disclosures.
- Expert consultation A sanity check for a board, benefits committee, or counsel weighing a PBM decision.
Also available to investors and law firms: independent drug-cost and pharmacy-benefit analysis for due diligence, and expert-witness support in drug-cost and PBM matters.
Who it's for
- Self-funded employers and Taft-Hartley health plans, roughly 500 to 5,000 employees. They are the plan sponsors responsible for the spending.
- The independent benefits consultants and ERISA counsel who advise them. They often bring Pollard Advisory in.
Why independent
No ties to any PBM, insurer, broker, or drug manufacturer. No rebates, no industry funding, and no referral fees in any direction. That independence is the whole point. A plan's fiduciaries can actually rely on what it finds.
Pricing
Flat, published fees. No contingency, no rebates, no hidden incentives. The same independence that makes the review trustworthy. The best first step is a free 30-minute call.
About Dan
Dan Pollard, PhD, MBA
Principal, Pollard Advisory
Dan founded a drug-cost transparency software company and ran it for 16 years, analyzing millions of pharmacy claims across more than 500,000 members. He holds a PhD in Medical Informatics and an MBA, both from Duke, and earlier led product and clinical strategy at leading healthcare-technology companies.
His edge is the actual claim-level data. He goes line by line, which few others do, to give a plan a clear, honest read on what it's really paying. He has no ties to any PBM, insurer, broker, or drug manufacturer.
Contact
Start with a free, no-pressure 30-minute call, or send a note.