Editor’s Note: The following post is taken from the Q&A session of IntegriChain’s Access Insights Conference: “The Latest on Channel and Revenue Leakage”. Responses have been edited for clarity. Click here to view the full webinar recording.

Manufacturers face constant challenges as the market access industry evolves. Growing costs and margin pressures, in addition to the influences of political rhetoric, come with a corresponding increase in the need to maximize the net revenue generated on every unit sold. A major challenge with maximizing profit is reducing revenue leakage. Our conference attendees gained insight into methods that can be used to mitigate leakage with chargebacks, Medicaid, and managed care. The key takeaway from this webinar is that manufacturers have to be extremely proactive when seeking to discover and control the sources of revenue leakage and this requires initial research as well as regular maintenance and analysis.

Below you will find questions that viewers asked our revenue leakage experts. You can find out more about the methodologies that IntegriChain uses to help manufacturers save significant amounts of money by viewing the full webinar.

 

Q: How frequently should we look for discrepancies in chargeback reversals versus 867 quantities?

A: We suggest a monthly basis at least. If you cannot handle it on a monthly basis, you want to take a look at it at least once a quarter. This also depends on your chargeback lag time. What is your lag time from your distributing partner when the chargebacks are submitted? Typically, we would expect distributors to submit chargebacks within two weeks.

 

Q: Do you recommend performing this analysis for just the big three or other wholesalers as well?

A: Start with the big three. The smaller wholesalers are easier to work with too. They can get on calls more easily, but the big dollar revenue leakage that we have noticed is with the big three.

 

Q: We currently obtain claim-level details in our Medicaid process, but have struggled with incorporating it in a timely manner. ​​Can you talk more about best practices to enable in-cycle dispute resolution for Medicaid claims?

A: That’s a common issue and in-cycle CLD validation is tough to do regardless of what your revenue management platform is, because most of them are not built with that integration already present.

You have to employ automation. If you have any scale at all, in terms of volume of products or volume of transactions, you would need to look to automation in terms of translating what you find in your CLD to the invoice level, which is where you actually record and communicate your disputes. If you can’t automate, you are likely going to have a tough time managing the disputes in-cycle. IntegriChain works with manufacturers that want us to deploy our RPA toolsets to obtain and validate CLDs while still incorporating the results of the validations into their existing revenue management platform.

Our ICyte platform does support an automated feed and translation of CLD disputes to invoice level disputes . We also work with a lot of manufacturers that have found a way to do it on their own and they typically look to automation (ETL tools, custom programming, etc) to help solve that.

 

Q: We have certain class-of-trade based restrictions in our upcoming commercial agreements. What do you see manufacturers using as a source of class-of-trade in those instances?

A: There is certain industry pharmacy data that will come with a self-reported class of trade. Some of the payers will expect you to read off of those industry databases, but we also see a lot of manufacturers (ourselves included) who invest in their own class of trade assignment. That can prove to be more effective because of the inaccuracies with the self-reported data. The ability to use your own class of trades is something you would need to negotiate with your payers.

 

Q: Has anyone figured out a workaround with the Cardinal PHS 340B contract bill to be shipped to? In short the bill listed the bill to which can make it hard to understand where the product was shipped.

A: We have had weekly calls with Cardinal to handle this situation. We have requested them to submit a DEA number where the product is being shipped in addition to the 340B ID. If we don’t receive that information, we also reach out to them to provide us via email an Excel spreadsheet so we can match the address and the shipping address and not just the bill to details.

 

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