- Access to documents is strictly controlled by some PBMs
Clients resist rules that restrict what auditors can examine
Susan Hayes can’t forget the trek from the parking lot, across a dusty patch of Arizona desert, to a dingy building without air conditioning and through a door marked “Scorpion Room.”
“Like something out of the Bates Motel,” said Hayes, a fraud investigator for employers, unions and health plans, and a longtime industry critic. In the Scorpion Room, she pored over hundreds of pages of nonpublic contracts between drug companies and a now-defunct pharmacy-benefit manager, a powerful middleman that processes claims and negotiates discounts and rebates.
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