SERVICES
Chargeback Processing
Program Services
Prescription Analytics provides services and support necessary for timely and accurate processing of pharmaceutical chargebacks including:
- Continuous Customer and Contract Setup and Maintenance
- Processing and Validation of all Submitted Line Items
- Processing and validation of all submitted line items
- Account Maintenance and Membership Eligibility as Required
- Assign Class of Trade
- Issue Resolution with Trading Partners
- Oversight and Reporting by Specific Contract Upon Request
- Admin fee reporting and validation
- Resubmission and duplicate claim monitoring
- Ad hoc reporting by contract or product line
Disciplined Chargeback Processing, Fueled by the Latest Technology
Chargeback processing, validation and reconciliation are integral to maintaining a profitable business in the U.S. pharmaceutical market. As a pharma manufacturer continues to grow and add more products and contracts, the complexity of ensuring the accuracy of the chargeback claims multiplies exponentially. For example, it’s common for a generic supplier to grow to 100+ NDCs across 50+ contracts, each with different pricing and effective dates needing to be managed. These manufacturers can expect to receive hundreds of thousands or more chargeback line items in a single month. If at any point during the month a chargeback validation fails or an incorrect claim goes unnoticed, the result is often detrimental to already slim profit margins.
Our disciplined chargeback process and proprietary system validates chargebacks on multiple levels (including contract price, product, contract ID, member ID and effective dates) with regularity to eliminate opportunities for errors or overpayment. Fueled by the latest technology, our cloud-based system and EDI transaction capabilities can support large volumes of chargebacks on behalf of our clients.
What is a Pharmaceutical Chargeback?
A pharmaceutical chargeback is a reimbursement claim submitted by a wholesaler to a drug manufacturer to account for discounted pricing, negotiated between a manufacturer and GPO or pharmacy, which the wholesaler honored when selling pharmaceuticals to an eligible pharmacy. So how does this happen?
Products are typically sold to wholesalers at the published Wholesale Acquisition Cost (WAC) price.
The entity purchasing the drugs from the wholesaler has a direct contract with the pharma manufacturer for a price lower than the Wholesale Acquisition Cost (WAC). Upon the wholesaler selling to the eligible entity, a chargeback invoice, for the difference between the contract price and the WAC, will be generated by the wholesaler to the manufacturer for verification and credit on the wholesaler’s normal invoice.
Brand pharmaceutical manufacturers may have limited exposure to chargebacks and chargeback processing. However, it’s likely chargebacks may come from the federal Public Health Services program (PHS) and/or VA Federal Supply Schedule.
Prescription Analytics reconciles the invoiced lines against contracts that may be eligible and the specific pricing terms of the agreement to verify chargeback legitimacy.
Key Insights
