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Who is Responsible for Saving Millions on your Company’s Patient Copay Programs?

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 to net.

Copay claims audits are relatively new and there is often uncertainty as to who / what department is responsible for initiating and paying for the project.

One of the major concerns is that the budget to pay for the audit may come from a non-brand location, however the savings that come from the project will be seen in the brand’s budget via reduced spending in the coming months and years. This is an issue that many companies struggle with (one department pays for the audit and another department benefits).

Depending on the company, the brand or the analytics team might own a copay claims audit, or, if the company is large enough, maybe the circle of excellence team would own it. Or maybe it would be the procurement team as they are the ones tasked with saving the company money. And last, but not least, finance might be the most appropriate department to oversee the audit as they are the budget gatekeepers for the company.

In my opinion, the department that should oversee a copay claims audit is the finance department as they control and distribute the budgets and can work out any budget maneuvering issues that arise. In addition, the ownership of a project like this must have buy-in from the top (CFO or VP of Finance) since the savings resulting from the audit benefit both the brand and the company. And another key reason that finance should run the process is that they can be objective without being protective of the job that is currently being done on the management of the copay program and the budget.

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