Audit: Aetna missed some contractual guarantees; auditors return roughly $59,000 to Titusville

An independent pharmacy benefits audit presented Jan. 29 to the Titusville City Council found that Aetna did not meet all contractual discount and rebate guarantees for the period Oct. 2023 through Sept. 2024.

"We saw about $2,400,000 in overall drug spend," said Ray O'Neil, senior audit manager at RxConnection/Arc Connection, who led the audit presentation. O'Neil said diabetic medications accounted for roughly 30.9% of the city's drug spend and specialty drugs represented about 30.5% of the total.

Auditors said they run a 100% claims review and exclude certain claims PBMs cannot reasonably control such as compounded prescriptions or over-the-counter items. After applying contract exclusions and aggregating results by channel, auditors said they identified guarantee shortfalls that produced a roughly $59,000 check to the city and estimated a $260,000 minimum-rebate shortfall.

"Aetna did not meet all guarantees," O'Neil said, explaining that contractual minimums require the PBM to make up any rebate shortfall. He said the audit team will recommend contract renegotiation and noted the city’s staff had already renegotiated some rebate and discount terms; the city plans an RFP process in 2026–27.

Council deferred detailed questions about implementation until staff (including a representative named Gina) can present additional analysis at a subsequent meeting. No legislative or procurement action was taken at the Jan. 29 session; the audit was presented for council information and next-step planning.