How it Works for You...

An estimated 25% of a drug's wholesale acquisition cost will be comprised of manufacturer rebates, most of which will go unclaimed. Altogether, available rebates represent S77 billion of S310 billion in annual drug spend in the US. CMS oversees this program as it relates to Medicaid State Drug Rebate Programs.

Because of fluctuating rebate levels, types, and opportunities, many healthcare providers have limited oversight into their overall rebate capture opportunity.

A survey of twenty-five healthcare entities found that 100% were unaware of the new rebates available to them.

Overview

Our rebate program is different than discount programs, such as discount coupons or the 340B program. The program is based on a data analytics platform which has partnered with drug manufacturers and stays constantly up-to-date with the latest rebates.

Rebates are available for a wide range of retail, specialty, outpatient and inpatient medications, and provides an additional revenue stream.

• Step 1: Medications are prescribed by prescribers. Prescriptions are transmitted to pharmacies for dispensing.

• Step 2: Eligible patients are identified who are not processing scripts through Third Party Plans.

• Step 3: Analytics platform identifies Brand/Rebate eligible prescriptions.

• Step 4: Process the Rebate-Eligible prescription through our platform, utilizing the BIN, PCN and Group provided. The Platform will initiate, monitor and manage all data submissions and Rebate management with each Drug Manufacturer.

• Step 5: Receive quarterly estimate Rebate and Repricing Report.

• Step 6: Quarterly Rebate Payment will be received 180 days after the end of the quarter on all qualifying drugs. (After the first payment, future payments will be quarterly.)

Performance

Processing prescriptions through the Rebate Management Platform will ensure that all possible rebates associated with eligible prescriptions are captured.

Example of Historical Analysis

Performance Estimate based on Historical Data, indexed to 10,000 prescription claims:

The Program

Advocate Consulting Group (ACG) provides Rebates for branded non-PBM billed medications.

The software delivers all of the functionality required to import all claim information from the pharmacy's data systems and convert the data to the appropriate format required for Rebate submission.

Our solution will convert, validate and resolve claims nightly.

At the end of each month, each ACG client will receive a report containing the information for all of the brand and brand specialty claims submitted , including the estimated total rebate dollars.

Qualified rebate claims are paid out 180 days after the end of the previous quarter.

ACG does not require any software to be physically implemented by facility. A data file containing

all claims needs to be supplied weekly by the client to the ACG to load to FTP site.

Once received, the file will be converted and submitted. The Aggregator will ensure that all proper information is received, verified and ready for rebate submission.

A detailed report of all claims submitted with the approximate rebate dollars is created and sent to the client quarterly.

At the end of each calendar quarter, all claims submitted are sent to the drug manufacturers.

Sample Data Sheet

This is an actual client's spreadsheet (sanitized) in which the columns from the pharmacy's data system has been pasted into the spreadsheet...

... A technician can transfer the data in just ten minutes each week!

Ready to Learn How Your Specific Pharmacy will Profit?