Script Management

Solve data retrieval, validation, and reconciliation challenges at scale

With IntegriChain CLD in place, one top-50 manufacturer identified $6 million in revenue leakage from a single state program, and on average, manufacturers utilizing CLD identify 1% to 2% of Medicaid liability in revenue leakage.

Pharma Script Management Technology to Minimize Revenue Leakage

Minimize Pharmaceutical Revenue Leakage with Script Management

For the most effective rebate adjudication, pharma manufacturers’ rebate management solutions should leverage a robust validation engine to scrub the utilization data received from the Commercial and Government payers. In IntegriChain’s ICyte application, the retrieval, load, and validation steps are embedded within the Managed Care, Tricare, and Medicare Part D Coverage adjudication process.

For Medicaid Claim Level Detail (CLD), retrieval and validation are offered as an enhancement to the standard Medicaid invoice adjudication service. Alternatively, for manufacturers who use another adjudication solution for Commercial and/or Government rebates, ICyte’s Script Management can be used as a stand-alone tool for retrieval and validation prior to feeding into the adjudication application. Retrieval of script level data and validation at that lowest level helps manufacturers curtail revenue leakage by ensuring they are only paying what is truly valid and owed.

Managed Care, Tricare, and Medicare Part D Coverage Gap data that manufacturers receive is already at the lowest level that can be provided. However, the Medicaid CLD which is the basis for the Medicaid invoices is not generally provided and must be either requested via email or retrieved via State or Third Party portal. Via ICyte, manufacturers have flexible options to choose from based on their pharma Script Management needs.

4 Step Chargeback Management Diagram: Retrieve, Standardize, Validate, and Dispute

Acquire Data

ICyte has built-in Robotic Process Automation (RPA) for streamlining the CLD retrieval process, while allowing manually retrieved CLD to be loaded via the front end

Standardize Data

As there is no mandated format for the CLD, each state and third party processor can have their own format. ICyte has a built-in file conversion tool to bring all CLD files into a common format in order to be used for validation.

Validate Data

ICyte contains a robust set of out of the box validations that all CLD is run against. Validating the CLD helps ensure that all claims are billed appropriately and identify potential disputes to reduce revenue leakage.

Review and Resolve Disputes

Produce potential disputes via the ICyte UI and operational reporting for action and extract for downstream adjudication. Dispute codes and backup are provided in order to support dispute resolution with the States, Third Party Administrators, and 340B Covered Entities.

Pharmacists Discussing 340b Pricing

340B Purchasing

With the year-over-year increase in 340B purchasing and a greater percentage of those purchases going through contract pharmacies, manufacturers are constantly on guard to identify covered entities purchasing at the 340B price who are also submitting for a backend rebate via Medicaid or Managed Care. Increasingly, manufacturers are establishing policies that put guardrails on the number of contract pharmacies that covered entities can use to be eligible for 340B pricing. Berkeley Research Group (BRG) and their Second Sight group are the leaders in defining these policies for manufacturers. As a result, Second Sight receives contract pharmacy sales from the covered entities that are stored in their proprietary 340B ESP tool. IntegriChain’s ICyte application leverages the 340B ESP data directly within the validation process to confidently identify 340B duplicate claims via contract pharmacies.. This synergy enables in-cycle identification of 340B duplicates thus eliminating inefficient “pay and chase” and ineffective “clawback” methods.

Commercial and Government Rebate

Rebate liability continues to increase for most manufacturers, so identifying even small numbers of disputes can add up to significant revenue leakage. Accessing pharma script level data and using that data as part of the invoice adjudication process is essential to in-cycle disputing. Manufacturers who rely on the outdated method of back money via the traditional “pay-and-chase” approach are often costly, inefficient, and time-consuming.

Commercial And Government Rebate Agreement
Pharma Breakdowns: Top-10 Pharma, Top-50 Pharma, Mid-Market Pharma, Top-10 Pharma

Interested in learning more?

Discover Agile Strategies for an Evolving C&P Industry

Case Study

Improving Revenue Leakage Through Better Medicaid Claims Validation

Adding CLD to the Medicaid rebate adjudication process can be a huge benefit in identifying and resolving additional issues and thus allowing for more accurate payments and accruals.

Read the Case Study


Considerations in Contract Pharmacy Policies for 340B

As 340B purchasing through contract pharmacies continues to increase year after year, manufacturers are responding through policies that address program integrity of covered entities purchasing through contract pharmacies.

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