School District Considers International Rx Sourcing & Independent Claim Audits

Watch the Ednburg Independent Insurance Committee learn (1) Their Rx spend is up 26.3% over last year, from $162.79 to $203.21 pepm, (2) International Rx sourcing could save over $600,000 on just one drug alone (Ozempic) and (3) Why Independent claim audits aren’t necessary because “Blue Cross audits every single claim.…’re only paying 29.6% of allowed charges.” NOTE: “Allowed Charges” are not billed charges.

The Edinburg Independent School District’s self-funded group medical spend has increased from $20,000,000 to over $40,000,000 in the past six years. Last month the district heard presentations on how to reduce spend including specialty drugs and claim audits.

Go to 38:00 to see discussion on international Rx sourcing. Then go to 1:35:00 to watch Blue Cross representative try to convince the district they don’t need to hire an outside claim audit firm because ” Blue Cross audits every single claim.”