RxParadigm’s Rebate Revenue Recovery Program: A Solution to Manufacturers' Inappropriate Rebate Claim Denials

#340b #drug #rebates #pharmaindustry #healthplans #coveredentities #payers #plansponsors #employers #pharma #innovationinhealthcare #managedcare #pbms

RxParadigm’s Rebate Revenue Recovery Program: A Solution to Manufacturers' Inappropriate Rebate Claim Denials

Executive Summary?

In the intricate ecosystem of drug pricing and discounts, the 340B drug pricing program presents numerous challenges for manufacturers, payers, and covered entities. Despite existing legal frameworks, duplicate discounting/discount stacking remains a persistent issue. Manufacturers, in an effort to navigate these waters, frequently resort to mitigation strategies with varying degrees of success. Consequently, payers often experience a significant loss in rebate revenues due to inappropriate denials based on presumed 340B claims. This presents yet another point of contention in the complicated 340B landscape. How does the industry solve this challenge? ?

The Problem Landscape?

Duplicate Discounting: Though legal measures are supposed to inhibit Medicaid duplicate discounting, they continue to arise at a significant rate. However, there are currently no such protections against duplicate discounts for Medicare and commercial rebate claims.?

Manufacturers' Mitigation Strategies: In the absence of a robust 340B claims validation system, manufacturers deploy strategies like contract pharmacy use restrictions and limit access to 340B pricing. This impacts covered entities negatively.?

Impact on Payers: Manufacturers’ limited 340B validation processes lead to the denial of legitimate rebate claims. In some cases, manufacturers block all claims indiscriminately from select pharmacies (in-house and contract pharmacies) from experiencing a rebate regardless of rebate eligibility. Payers suffer undue rebate revenue losses because a growing number of claims denied for 340B reasons are, in fact, rebate eligible.?

RxParadigm’s Solution: Rebate Revenue Recovery Program Powered by Tungsten+ PLUS?

Robust Validation: RxParadigm's proprietary technology, Tungsten+ PLUS, provides comprehensive 340B claim validation. This ensures that legitimate claims are not denied based on inaccurate 340B presumptions.?

Benefit for Payers: By ensuring accurate validation, the Rebate Revenue Recovery program empowers payers to recover the rebate revenues that would have otherwise been lost due to inappropriate denials.?

End of Duplicate Discounting: With the advanced capabilities of Tungsten+ PLUS, duplicate discounting scenarios, whether in Medicaid, Medicare, or commercial claims, are effectively eliminated. This secures both the manufacturers' and payers' interests.?

Transparency and Compliance: The program not only ensures the rightful rebate claims of payers but also upholds program compliance for covered entities. This establishes a transparent system where each stakeholder reaps their deserved benefits without undue losses.?

The Way Forward?

RxParadigm’s Rebate Revenue Recovery program signals a new era in the realm of pharmacy claim validation. By ensuring that manufacturers have a comprehensive 340B validation process, RxParadigm has not only solved a major pain point for payers but also streamlined the entire 340B ecosystem. ?

As more stakeholders adopt this solution, we can expect:?

• A significant reduction in inappropriate rebate denials.
• Enhanced trust between manufacturers, payers, and covered entities.
• A more transparent and efficient 340B drug pricing program.?

Conclusion?

In a landscape riddled with inefficiencies and losses, RxParadigm’s Rebate Revenue Recovery program emerges as a beacon of meaningful progress. By ensuring that payers receive their rightful rebates and eliminating the thorny issue of duplicate discounting/discount stacking, this innovative solution promises a more harmonized and efficient 340B ecosystem for all involved parties.

?