Certified Pharmacy Audit Specialist (CPAS)

CPAS (AUD-001) Exam Objectives

This exam certifies that the candidate has the knowledge and skills to effectively manage both internal and external pharmacy audits, ensuring compliance and minimizing financial risk.

Domain 1: Pharmacy Auditing Principles and Standards (25%)

• Types of Audits: Differentiate between various types of audits, including on-site, desktop, investigatory, and educational audits.
• Audit Triggers: Identify common triggers that lead to a pharmacy being selected for a PBM audit.
• Legal and Contractual Rights: Describe a pharmacy's rights and responsibilities during the audit process as defined by state laws and payer contracts.

Domain 2: PBM and Payer Audits (40%)

• Audit Preparation: Manage the process of preparing for an external audit, including the retrieval of prescription records and signature logs.
• Common Discrepancies: Identify the most common types of audit discrepancies, such as invalid prescriptions, signature log issues, and incorrect days' supply calculations.
• Appeals Process: Manage the multi-level appeals process for challenging audit findings and chargebacks.

Domain 3: Internal and Compliance Auditing (25%)

• Self-Audits: Develop and conduct a proactive internal audit program to identify and correct potential compliance issues before an external audit occurs.
• Compliance Areas: Audit for compliance with key risk areas, including billing for controlled substances, specialty drugs, and compounded prescriptions.
• Fraud, Waste, and Abuse (FWA): Identify potential FWA and understand reporting requirements.

Domain 4: Audit Response and Remediation (10%)

• Corrective Action Plans: Develop a Corrective Action Plan (CAP) in response to credible audit findings.
• Communication: Communicate audit results and remediation plans to pharmacy staff and management.

Eligibility Requirements

To be eligible to sit for a CPS certification exam, candidates must meet the criteria outlined in one of the two pathways below.

Pathway 1: For U.S. Licensed Pharmacists

This pathway is for pharmacists licensed to practice within the United States, regardless of country of graduation.

• Hold an active and unrestricted pharmacist license in any state or territory of the United States.
• Meet educational requirements by being a graduate of an ACPE-accredited school of pharmacy or holding a Foreign Pharmacy Graduate Examination Committee® (FPGEC) Certificate.
• Fulfill the specialty experience requirement as outlined below.

Pathway 2: For International Pharmacists (Non-U.S. Licensed)

This pathway is for pharmacists who practice outside of the United States.

• Hold an active and unrestricted license to practice pharmacy in their country of practice. A certified English translation of the license must be provided if the original is not in English.
• Hold a professional degree in pharmacy equivalent to a U.S. pharmacy degree, such as a Bachelor’s degree (BPharm), Master’s degree in Pharmacy Practice (MPharm), or Doctor of Pharmacy degree (PharmD).
• Fulfill the specialty experience requirement as outlined below.

Specialty Experience Requirement (for all pathways)

To ensure candidates have foundational knowledge in the specialty, one of the following criteria must be met:

• Standard Pathway:
  Completion of at least one year of professional experience in a practice setting directly related to the certification area.
• Certificate Pathway:
  The one-year specialty experience requirement is waived for candidates who hold an active certificate of completion from a nationally recognized provider in a related subject matter. This includes, but is not limited to, the completion of a relevant PGY residency, fellowship, certificate/training program, or a relevant graduate degree (e.g., a Master's degree in the specialty field). Recognized providers of certificate programs include, but are not limited to:
  • American Society of Health-System Pharmacists (ASHP)
  • American Pharmacists Association (APhA)
  • American College of Clinical Pharmacy (ACCP)
  • American Society of Consultant Pharmacists (ASCP)

Career Path for CPAS Professionals

The CPAS certification is for pharmacists and experienced professionals who focus on the financial integrity and compliance of pharmacy claims. This is a critical skill set for roles in pharmacy administration, community pharmacy ownership, and managed care.

Target Candidates

• Pharmacy owners and managers responsible for profitability and compliance.
• Lead pharmacy technicians or administrators who handle third-party contracts and billing.
• Consultants who specialize in pharmacy operations and PBM audit defense.
• Professionals working for PSAOs or other organizations that support independent pharmacies.

Primary Job Roles:

• Pharmacy Audit Specialist
• Pharmacy Compliance Manager
• Director of Pharmacy Operations
• Consultant (PBM Audits)
• PSAO Field Representative or Manager

Career Advancement:

A CPAS is positioned for leadership roles in pharmacy finance and operations. They can advance to become a Director of a pharmacy network, a senior leader in a Pharmacy Services Administration Organization (PSAO), or an independent consultant specializing in audit defense.

Study Resources

Prepare for your CPAS exam with resources designed to master the complexities of pharmacy audits.