Both Revitas and Model N bring out enhanced script-validation modules to ensure rebate accuracy
With the Affordable Care Act and the tightening constraints of managed care in all types of pharmacy benefit management, the importance of getting contracts with payers and customers climbs ever higher. Revitas (Philadelphia), one of the long-time players in this area, cites clients who have saved tens of millions of dollars annually in more accurately analyzing the script data they have received. Both it and one of its competitors, Model N (Redwood Shores, CA) have come out with enhanced software modules to manage this and related processes. Historically, script data (when it was analyzed at all) came from payers in summary form; now it is being obtained as scripts are filled and can be associated with specific payers and prescribers.
In Model N’s case, the company has introduced Release 5.7 of its Life Sciences Revenue Management Suite, featuring upgraded capabilities of the earlier-announced ScriptValidate module. ScriptValidate enables users to “scrub” data coming from payers and other customers, a necessary step to accurately calculate rebates and discounts being credited. The company also emphasizes recently enhanced capabilities for managing pricing in global markets; Ajay Dawar, VP, product management, notes that its latest upgrade was propagated to its clients quickly via the cloud-based platform that it employs.
At Revitas, the company has extended its Validata solution, in use for several years in commercial contracts, more deeply into government-pricing markets, including Medicaid, 340B programs and “coverage gap disputes” involving Medicare Part D. Managing rebate payments can be a costly and time-consuming burden for manufacturers that slows processes and increases the risk for errors that can lead to significant revenue loss,” said Jon Brier, product line manager, in a statement. “The three new modules for the Revitas Validata solution automate validation of claims at the script level to confirm submission accuracy and manage disputes, thereby reducing the erroneous payments that cause revenue leakage.”
“Better contract management of these programs can result in a 3-10% adjustment in rebate exposure for a typical pharma company,” Jon Smith, director of industry development at Revitas, sums up. “That can have an impact on earnings-per-share when pharma companies make quarterly reports to Wall Street—and that should get the attention of CFOs.”