Billed $14. Pharmacy got $4. Find the $10 on every claim.
A free check any health plan, employer or union can run on its own pharmacy claims. Paste or drop a claims export and it lines up what the plan was billed against what the pharmacy was actually paid, by drug and by channel, then shows how a blended discount guarantee can be met while the expensive lines miss by a mile. Everything runs in your browser. No claim leaves your computer.
1. Paste your claims, or drop a CSV
One row per claim or per drug and channel. Headers are matched loosely. Required: ndc, billed (what the plan was charged), paid (what the pharmacy was reimbursed). Optional: drug, channel, type (brand/generic), claims, fee_billed, fee_paid, awp or list_price, and a reference price column such as cost_plus or nadac (per claim). Where do you get paid? From the pharmacies: every one of them has a remittance for every claim.
2. Where the money went
3. By channel: who collects the dispensing fees
4. The averaging trap
5. By drug: the renegotiation list
Want this run on your claims, with the contract read next to it?
Send the claims export and the PBM contract. You get the spread by drug, the fee split, and a written list of what to renegotiate.