Written By Jen Proudfit, Executive Director of Sales and Business Development
Rebate reconciliation is essential for ensuring you’re not leaving money on the table in your pharmacy rebate agreements. However, the process can sometimes become complex without clarity and a structured approach. To simplify the process, start by asking these key questions:
What Claims Qualify for Rebates?
Understanding which claims are eligible for rebates is critical for accurate reconciliation since many contracts often include specific exclusions that can impact your expected rebate value. These common exclusions may include vaccines, compounded drugs, and over-the-counter medications.
By clearly defining eligible claims, you ensure you know precisely what prescriptions should be assigned rebate value and minimize the risk of over or under-calculation and discrepancies early in the process.
How Are Drug Channels Defined?
Different dispensing channels – like retail, mail order and specialty pharmacy—are often treated differently in rebate agreements. Aligning on channel definitions ensures that all parties use the same criteria when calculating rebate values. Without alignment, discrepancies can add up and cause financial losses.
What is Your Timing for Reviews?
The timing of a rebate reconciliation is key for catching issues early and avoiding long-term negative financial impact. While annual reviews may seem sufficient, quarterly reviews are ideal to compare your expected payments to your vendor’s calculations. This will allow you to identify discrepancies quickly, recover missed rebate value in a timely manner, and ensure ongoing accuracy in the rebate process throughout the year.
Ensuring Accuracy and Confidence in Your Rebates
By asking the right questions and establishing a structured process, you help ensure you are not leaving money on the table and optimizing your savings.
Rebate reconciliation doesn’t have to be overwhelming. If you’re looking for support to navigate this process, Gateway Health Partners can help. Our team of industry experts specializes in ensuring you maximize your savings with clarity, insights and expertise in pharmacy and medical rebate management.
Contact us today by emailing [email protected] to see how we can help streamline your rebate reconciliation and deliver savings you can count on.
