Solutions
Build compliance into every pharmacy claim
CoverMyMeds compliance protection helps pharmacies identify audit risks, validate claim and prescriber details, and address program requirements within the dispensing workflow. Integrated safeguards support more consistent compliance across retail, specialty and health-system operations without adding another manual process.
The challenge for compliance protection
Pharmacy audits are costly, time-consuming and can result in significant financial losses. Whether triggered by discrepancies in claims, government regulations or coordination of benefits issues, audits disrupt workflows and put reimbursements at risk. Pharmacies need proactive solutions to support compliance and help reduce audit exposure before issues arise.
Proactive solutions help support compliance to reduce audit exposure
Integrated safeguards help pharmacy teams address compliance requirements with greater consistency, while reducing avoidable corrections and operational disruption.
Protection that works where claims are processed
Compliance checks are easier to use when they are part of the dispensing process. CoverMyMeds solutions deliver validation, alerts and guidance within the existing pharmacy workflow, helping teams respond without shifting between systems or relying on separate manual checks.
Compliance risks are getting harder to absorb
Audits, payer scrutiny and government program requirements create real financial and operational pressure. CoverMyMeds helps pharmacy teams reduce avoidable risk with safeguards built for everyday claim decisions.
average audit cost for pharmacies
The average pharmacy experiences three third-party audits per year, with nearly all pharmacies facing at least one annual audit
monthly alerts
1.5M+ monthly alerts supporting CMM network pharmacies at the point of claim
More than 50,000 pharmacies are a part of the CoverMyMeds ecosystem
Compliance solutions for pharmacy risks
Choose the safeguards that align with your pharmacy’s audit, government program, prescriber and patient safety needs. Solutions can work individually or together.
Audit Intervention Service
Flags plan limits, quantity overages, incorrect day supply and other common audit triggers during dispensing.
Government Plan Exclusion
Identifies government-funded prescriptions to support appropriate claim handling.
Coordination of Benefits Blocking
Provides real-time rejection messages when COB claims don’t meet defined criteria, helping pharmacies correct and resubmit.
Prescriber Schedule Authority
Validates DEA information and schedule authority for controlled substance claims.
Excluded Prescriber Monitoring
Checks prescribers against state and federal exclusion lists before claim submission.
RxSafety Advisor® Advanced
Provides alerts for look-alike or sound-alike drugs and higher-risk patient populations.
Audit Intervention Service
Flags plan limits, quantity overages, incorrect day supply and other common audit triggers during dispensing.
Government Plan Exclusion
Identifies government-funded prescriptions to support appropriate claim handling.
Coordination of Benefits Blocking
Provides real-time rejection messages when COB claims don’t meet defined criteria, helping pharmacies correct and resubmit.
Prescriber Schedule Authority
Validates DEA information and schedule authority for controlled substance claims.
Excluded Prescriber Monitoring
Checks prescribers against state and federal exclusion lists before claim submission.
RxSafety Advisor® Advanced
Provides alerts for look-alike or sound-alike drugs and higher-risk patient populations.
Pharmacy insights
Talk to a pharmacy solutions specialist
Compliance priorities differ across retail, specialty and health-system pharmacies.
Tell us where your team is seeing risk, from audit triggers and government program requirements, to prescriber validation or workflow consistency.
A CoverMyMeds pharmacy solutions specialist will follow up to discuss your needs and identify relevant solutions.