Forensics Pharmaceutical Revenue Management Services

With our knowledge and experience, we can bring a powerful blend of technical experience, industry insight and robust automation tools to the table that can help drug manufacturers meet complex government pricing and Medicaid rebate requirements.

Drug manufacturers participating in government drug pricing programs need to capture, understand and analyze complicated data sets and inputs to fulfil myriad federal and state program and contract obligations. Interpreting those rules accurately and correctly can mitigate compliance risks and sometimes make the difference between profit and loss on a new drug program.

Through our cutting-edge technology and team of resources with deep industry and regulation knowledge, we provide a full range of support aimed at helping you improve efficiency and meet your obligations.

  • Pharmaceutical Government price reporting

    Through the combination of technical know-how and effective technology, our Government Pricing Module (GPM) provides confidence through reliable, configurable, and transparent technology and partnership. Implementation time for clients to transition to our GPM is typically 25%-50% shorter than competitors, and no hardware or software maintenance required allows our clients more time for analysis.

  • Medicaid rebate processing

    Our Medicaid Rebate Module automates the manually intensive process of paying Medicaid rebates through innovative technology that relies on analytical tools, visuals and tracking methods.

  • Commercial rebate processing

    Our Rebates Module provides flexibility and automation options to enable accurate and efficient rebate processing with reporting and analytics to identify effective and ineffective deals.

We can help you:

Empower your analytics team

  • By providing a more comprehensive view of your data, we help you focus on your proprietary advantages and identify new product strategies.

Optimize your go-to-market strategy

  • Obtain a better ROI in government pricing contracts by mining your data for key insights. We model multiple scenarios so you can avoid limiting your revenue potential for one-off deals.

Reduce revenue leakage

  • Securing a more comprehensive view of your obligations to the government helps only pay what you owe.

Experience

As a part of a Medicaid Drug Rebate program pricing restatement effort, we worked with a major pharmaceutical manufacturer to reclassify more than 300k customer class of trade (COT) assignments using several data sources and a proprietary algorithm. We assigned >95% of customers through automation, saving significant time and money for our client. Since implementing the automation for ongoing support, manual review hours have been reduced, enabling our client to focus on operational efficiency and analytics.

We assisted a biopharmaceutical manufacturer that was in the midst of a product launch enter contracts with the Department of Veterans Affairs (VA) and Centers for Medicaid and Medicare Services (CMS) for participation in the Federal Supply Schedule and Medicaid Drug Rebate programs. We supported the client in drafting methodology and policy documents, gathering data needed for calculations (using EY technology) and considering pricing implications associated with participation in government pricing programs. This supported a smooth and efficient product launch.

We guided a major pharmaceutical manufacturer through a large Medicaid Drug Rebate program pricing restatement. This project spanned multiple years, involving updates to product master attributes, customer classes of trade and transaction type classifications to comply with CMS rules and regulations. Following the successful restatement, the client determined that the EY solution was more efficient and customized to their needs and transitioned to our solution for ongoing government pricing operations, calculations and Medicaid processing.

Using the EY Medicaid Rebate processing technology, our clients have been able to recuperate significant and material amounts. When a manufacturer does a government pricing restatement or best price (BP) true-up that results in a decreased unit rebate amount (URA), many states do not automatically submit adjustments for overpayments. Our technology automates the identification of those situations so the manufacturer can apply those balances toward rebates owed to states, preventing revenue leakage.

EY can help 

Whether you outsource your entire operation to us, or just work with us to analyze your data, we can help you benefit from our knowledge and experience with government pricing contracts as well as with multiple life sciences companies. 

Our teams can help manage the process efficiently and consistently, making the process easier and less complicated so your people can focus on what’s really important: driving value for your organization through analytics and strategic insights.

We can compare options with your current software vendor, and explore where EY can add value and efficiencies across the board.

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