Government Pricing & Rebate Processing Services

Program Services

Prescription Analytics provides full-service support for all activities required for federal and state pharmaceutical programs. This begins with helping secure federal and state contracts supportive of a client’s commercialization strategy and then includes but is not limited to:

Medicaid Drug Rebate Program (MDRP)
  • Government Pricing calculations
    • Calculate and submit to CMS Average Manufacturer Price (AMP), Best Price, Nominal Price, Customary Prompt Pay Discount and Unit Rebate Amount (URA)
    • Complete additional required government submissions (e.g. Texas formulary, HAD (old HDMA))
    • NDC-level AMP variance reporting
  • Quarterly rebate invoice capture, reconciliation, payment, dispute management and reporting (across 300+ Medicaid programs)
    • Invoice capture
      • Manage client portal access across all PBM/state portals
      • Collect Medicaid invoices across all 300+ state government programs (includes digital and mail/printed invoice formats)
      • Enter invoice data into our proprietary rebate management system – removing duplicate and redundant statements for dispute resolution
      • Track against client history and conduct quarterly program audits to secure invoices from state program statements that were never received
    • Invoice reconciliation
      • Proactively manage quarterly invoices to ensure adherence to strict deadline requirements
      • Reconcile state invoices against client history in our proprietary rebate management system
      • Execute disciplined audits on the following values to confirm invoice accuracy prior to payment processing: URA validation, utilization validation and reasonability testing, customized validation for unique products and packaging types, rounding/penny balance validation, interest/adjustment validation, validate zero-dollar invoices against prior payments or credits to avoid unnecessary processing
      • Review of reconciled invoices from state programs or processors with a history of errors, full audit of ADAP and supplemental programs and claims level detail (CLD validation where appropriate)
    • Invoice payments
      • Maintain a unique checking account with anti-fraud positive pay protection
      • Print and mail checks and required backup documentation on behalf of clients for all state programs
      • Financial audits for payment validation
    • Disputes and resolution/credit management
      • Resolve discrepancies with state entities to ensure accurate payment application and balances
      • Provide supporting backup documentation as required
      • Leverage our scope, scale, and relationships with states and PBMs to drive improvements with processing entities
    • Historical record build and validation
      • Review all client MDRP invoices and payments against state/PBM records
      • Manage discrepancy resolution with states/PBMs to ensure accurate payments are processed and valid credits are applied
      • Build historical records for clients and state/PBMs for more accurate and efficient processing of Prior Quarter Adjustment Statements (PQAS)
    • AMP restatement related to special projects
      • Process PQASs as needed due to AMP restatements
      • Manage all facets of credit recovery from state programs
    • Reporting capabilities
      • Full history payment reports
      • NDC and program level detail showing clients what was processed for each batch/quarter
      • Credit tracking by labeler and state program
      • Regulatory changes impacting future accruals
      • Trends in top-Medicaid rebate states
      • Client-defined reports as required
  • Timely submission of all new product registrations with CMS (Centers for Medicaid and Medicare Services) and any required state-specific programs
PHS / 340B
  • Complete PHS quarterly pricing calculations
  • Complete required submissions to PHS portal
  • Comprehensive management of PHS/340 entity notifications and payments
  • Communication of pricing to required stakeholders
  • Complete and submit Federal Supply Schedule (FSS) Solicitation for new labelers
  • Complete and submit FSS Non-FAMP/IFF calculations
  • Complete Annual FSS Public Law Federal Ceiling Price calculations and submissions
  • Monitor and update Tracking Customer if required
  • Prepare all modification forms for submission to VA
  • National Award Contract CRF/IFF (Cost Recovery Fee/Industrial Funding Fee) calculations
  • SAM registration support
  • Receive and reconcile quarterly Tricare Rebate invoice
  • Complete claim validation process
  • Processing of rebate payment through client Rebate Checking Account
  • Provide quarterly report to client and electronically archive related data
Medicare Part D Discount and Rebate Program
  • Establish plan participation; complete and submit required contracting applications
  • Secure access to CMS TPA Web Portal
  • Download quarterly discount data and complete reconciliation
  • Validate, reconcile and manage annual inflation penalty rebate
  • Prepare client ACH payment summary report for approval
  • Upload batch payment reports to the portal and release funds
  • Follow up on and track ACH transaction completions
  • Archive all related data
Medicare Part B – Physician Administered and Injectable Products
  • Select and organize required business data
  • Calculate ASP, submit to client for approval and submit via ASP reporting portal
  • Validate, reconcile and management of quarterly inflation penalty rebate
Affordable Care Act Brand Tax
  • Complete required confirmations and submissions
  • Complete annual reconciliation and payment reporting

Turnkey Support

Prescription Analytics provides turnkey support for Government Pricing and Rebate Processing Services in the following areas:

  • Pricing Calculations and Submissions to regulatory authorities for all federal and state pharmaceutical programs (includes AMP, Best Price, Nominal Price, URA and more)
  • Rebate Invoice and Discount Program reconciliations, payments and submissions
  • Regulatory Updates and Impact Analysis communication regarding pharmaceutical government contracting, pricing and discount programs
  • Dispute Resolution with all government entities
  • Secure Archival Records of all historic datasets
  • Executive-level Reporting on Medicaid Rebates (ROSI/PQAS, units dollars, top states), Medicaid Credits, AMP and URA trends, and regulatory trends and impact summaries

High Tech Solutions Create Greater Accuracy & Efficiency for Our Clients

Cloud-Based Technology

Highly Configurable Outputs

On-demand Access

Multi-layer Accuracy Audits

User-friendly Interfaces

For more information regarding our Government Pricing and Rebate Processing services, contact our team of experts today.

Contact Our Team