Through our work doing copay program optimizations and audits, we have found there are a few key components that increase the likelihood a program will be targeted for fraud by cunning, mostly independent pharmacies. Copay programs with a high annual cap are often targets for fraud.  It’s the flexibility and

Most pharma companies have never done a copay claims audit looking specifically for incorrectly processed claims and pharmacy fraud. This is an interesting fact since spending on copay programs was almost ten billion dollars in 2022. Audits can deliver millions of dollars of savings along with big improvements in gross

Ask most pharma teams if they are doing “copay audits” today and most will say they are. Most don’t realize there are two different types of copay related audits. A copay vendor audit is the one everyone is most familiar with and is most often performed by one of the

There are many ways that your program can be manipulated at the pharmacy level (retail or specialty pharmacy). It doesn’t take much for an experienced pharmacist to get around your established program rules if they are determined to do so. Your business rules can leave the door open for experienced

If you are a pharma manufacturer today, you most likely have a patient copay assistance program in place as it is a necessary piece of your patient affordability strategy. You may feel these programs are set up with pretty strict business rules which should ensure that your monies are going