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RX ANALYTICS ON DEMAND CASE STUDY

TOP HEALTH SYSTEM REALIZES MULTI-MILLION DOLLAR REVENUE OPPORTUNITY WITH INMAR’S RX ANALYTICS PLATFORM

SITUATION

A large, nationally ranked health system was losing revenue through an unexplained discrepancy in their usual and customary (U&C) claims. They needed a way to identify the cause of that discrepancy, improve reliable data visibility, and make better informed future pricing decisions:

  • In 2020, the health system implemented a new retail pharmacy dispensing system. Their prior dispensing system had integrated U&C monitoring capabilities, but the new system did not have similar functionality.
  • In the spring of 2021, the health system began using Rx Analytics on Demand (Rx AOD) to closely monitor their business and realized that their reimbursement rates (% off AWP) were much lower than similar peer comparisons. 
  • They asked Inmar to help investigate this reimbursement variance. It is common for Pharmacy Benefit Managers (PBMs) to reimburse pharmacies the lower value between contracted rate and U&C; so using Inmar’s Rx Analytics on Demand platform, they were able to identify instances where reimbursement was significantly lower than industry benchmarks, resulting in limiting revenue.

STRATEGY

  • This health system turned data into actionable insights by using Rx AOD to produce an in-depth pricing intelligence analysis. 
  • Through this analysis, Inmar was able to reveal that this top health system’s U&C reimbursement was significantly lower than their peer health systems. 
  • Rx AOD was then used to identify which NDCs had the largest U&C discrepancies. 
  • To better align with industry benchmarks, the health system adjusted select U&C prices to avoid revenue shortfalls.
 

RESULTS

  • From June to August 2021, this health system realized an increase of $1.3M in revenue due to U&C adjustments.
  • Revenue will continue to increase as a result of more accurate U&C price values
  • The health system will optimize revenue capture and avoid unnecessary financial shortfalls  by continuously monitoring reimbursement rates and U&C on an ongoing basis 
  • Future pricing decisions will be driven by enhanced visibility through Rx Analytics on Demand.