PIC is the only pharmacy benefits consulting and investigation firm owned by a Licensed Private Detective with over 35 years of health care experience.

Zero Conflict of Interest

Pharmacy Investigators and Consultants maintains independence and avoids any conflict of interest in part by how we provide consulting services. We are paid by our clients on a flat fee basis. Every project has a quoted price that Pharmacy Investigators and Consultants does not exceed unless the scope of the project changes.  

We do not retain commission or any monies from PBMs, unlike other consultants.  Our obligations are solely to our clients to get the job done timely and accurately and without industry bias.

Our History

Founded in 1996, Pharmacy Outcomes Specialists was one of the most experienced consulting firms having performed over 1,000 pharmacy benefit audits and reviewing the accuracy of over 200 million pharmacy claims. Projects encompassed managing large complicated audits of Medicare Part D programs, rebate audits and audits of Pharmacy Benefit Managers (PBMs) for compliance to plan terms and government regulations. POS also served the broader pharmacy benefits industry through hosting our annual pharmacy benefits educational conference. Our consultants and partners are a unique group of pharmacists, pharmacy technicians, accountants, financial analysts, attorneys and government program specialists.

In January 2019, Pharmacy Outcomes Specialists rebranded to become a powerful force in the pharmacy benefits arena. Combining 23 years of employee benefit consulting experience, with leading edge software programs and investigation services aimed at detecting and recovering dollars lost to fraud, waste and abuse in pharmacy networks, we became Pharmacy Investigators and Consultants (PIC), a woman-owned business enterprise (WBE).

During a growth period, PIC developed state of the art computer systems that score and audit claims for potential fraud. COPs (Cluster Optics Process), based on criminological theory, automatically ingests millions of claims a month and scores claims for potential fraud merging claims data with Big Data. CARs (Claim Audit Recovery System) is the auditing system for chains and independent pharmacies and allows for cost effective auditing of claims identified by COPs. When the auditing process is complete, CARs sends COPs audited data for machine learning.  

PIC also developed P3, a Pharmacy Procurement Portal for brokers and consultants, whereby the industry can view contract terms and advisors can run data to test if their current pharmacy benefit financial performance guarantees are market competitive. This provides up a whole new layer of transparency in the industry. Pay a small fee, run your data and no longer are you beholden to PBMs that keep you trapped in poor contracts.

In 2026, we take another step toward the future. Today, plan sponsors need a better understanding of this whole new world of transparency. Once locked into traditional PBM offerings that dictated terms, plan sponsors who move to more innovative arrangements need to learn about options that are now available. Should a plan sponsor engage its PBM to perform Prior Authorizations?  Who should write the PBM contract? How should the retail, mail order and specialty network be configured?  What drugs should be on a formulary? PIC can assist and educate sponsors about transparent options and offering.

Litigators also need assistance with complex prescription drug issues; it is a complicated industry. We can assist with a broad knowledge of the industry, understanding of pharmacy laws and deep expertise with fraud investigations. We have represented drug manufacturers, PBMs, plan sponsors and state and federal litigants with expertise and support, including landmark cases such as Rutledge v. PCMA and Garbe v Kmart.

Why We Do It

Since 1996, our mission has been clear and unwavering: To provide plan sponsors and the broader industry with expert pharmacy benefits advice, unbiased from any industry influence, to lower costs and increase the health and productivity of the membership.

When Pharmacy Outcomes Specialists started in 1996, pharmacy costs were $200 per member per year. There were no consulting firms at that time specializing in just pharmacy benefits consulting. But Pharmacy Outcomes Specialists founders realized with the United States workforce growing older and technology advancing, prescription drugs were going to be more important than medical costs in terms of employee productivity, member satisfaction and bottom-line profits. By 2025, drug cost per member per year average over $2,000, with retiree costs as much as $5,000 per year.

At the same time drug costs have increased, publicly traded pharmacy benefit managers – the middlemen between pharmaceutical companies and plans sponsors– have returned significant profits for their shareholders.  Many have merged until there are “the Big Three” which has reduced plan sponsors’ ability to negotiate. Profits have come, in part, by creating margins between what pharmacies are reimbursed and what plan sponsors pay for the same prescription order and carving up drug rebates into dollars retained by the PBM and dollars that the PBM elects can be passed back in portion to the plan sponsor through insidious Group Purchasing Rebate Aggregators, the majority of whom operate outside the U.S.

The convergence of complex pricing rules, advanced computer technology, expensive lifesaving specialty drugs and a blend of specialty drugs/brand/generic/over the counter/behind the counter product array results in significant challenges to manage costs and maintain member satisfaction. Our role is to clear the clutter, provide data to make better decisions and be unfettered by industry influence.