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Selection & Customization of a Rebate Processing Application

Industry
Health Care - Prescription Benefits Management
Software Package(s)
Customized Package / NT, PowerBuilder, IIS 4.0, SQL Server DB
Background
The Pharmaceutical market is a complex and fast changing market as Pharmaceutical companies position their products, and provide incentives to the PBM’s to include their products in the formularies (a preferred list of drugs that a member can use). Pharmaceutical Manufacturers provide rebate incentives to Prescription Benefit Management (PBM) companies to include their products within their formularies.
Challenge
The rebate processing for the client was handled by an outside firm which presented the following challenges:
  • Ability to capture all eligible rebates
  • Excessive Processing turn around time
  • Premium charged for their service.
Solution
At the time, rebate processing was rather new and had recently grown in complexity. There were no standard software applications that could be evaluated, purchased, and implemented; however, several companies had well developed systems which could provide the foundation to build an application. A study was conducted of a buy vs. build.

The client had several business partners which had their own rebate processing system, but none were as complex or could handle the volume.

The result was a shell of the application was purchased, and customized to handle the unique needs of the business model and the complex changing rebate market. The application afforded timely process rebate claims and capture additional rebate dollars based upon the flexibility of the application.
Result
The project was delivered on-time and under budget with the following results:
  • 99% Rebate claim capture (up from 80%)
  • Processing time reduced by 60%
  • Reduced rebate operating costs by 54%
The client then offered the rebate processing to other PBM’s as a new business offering which expanded their revenue base, and only compounded the already positive ROI.