This Essential Step is Missing at Most Pharma Companies

Determine the impact of “incorrectly processed” and fraudulent claims

Incorrectly processed claims can quickly add up to millions of dollars of wasted spend.  A copay claims audit uncovers and quantifies costly “processing errors” and fraud and is a critical step in copay program optimization. Pharmacies manipulating claims are identified for follow up and can be continually monitored.

The NCPDP technology platform the copay programs run on is old and out of date. Add to that fact the copay program spending is now the #1 or #2 cost line items for most brands and you realize copay spending should be looked at under a microscope. Bands need to know the details of their copay program inside and out.  As the old saying goes: “Don’t expect what you don’t inspect” & “trust but verify”.

Our audit process digs deeper than the traditional process followed by copay vendors.  We analyze program claims from the bottom up, program by program, rather than simply across programs and manufacturers.  As an objective 3rd party that has been working with claims level data since 2009, we are uniquely positioned to perform a claims audit.

Importantly, a detailed claims level audit provides insight into whether the program execution at the pharmacy level matches the business rules and objectives for the program.  The ROI on copay claims audits can be significant so it’s important to identify issues early before spending gets out of control!

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