As pharmaceutical manufacturers struggle to remain profitable in today’s difficult business environment, ensuring the accuracy of managed-care rebate spend is crucial. This spend can account for more than 20% of a manufacturer‘s gross sales. A recent survey of 117 pharmaceutical manufacturers indicated they consistently overpay managed-care rebates by an average of 5.5%. This revenue leakage can have a serious impact on the bottom line. But Connolly can help.
Our reviews are highly customized based on client need. We focus on areas of complexity and change. Our employees have worked for big pharma as well as PBM's and know where holes may occur. We can perform data scrubbing as well as much deeper reviews of contracts, formularies and benefit designs.
Our reviews include:
· Formulary, benefit design, client lists, and customer contracts.
· Clinical review of aberrant unit quantities for each NDC, including verification with dispensing pharmacy.
· Market share and performance criteria evaluation.
· Identification of duplicate claims within each submission, across contract entities, and across prior submissions.
· Reconciliation of invoice and claims detail.
· PBM site visit to review adjudication process.
· Root cause analysis and custom audit reporting.
· Audit results management presentation. |