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Enhance Patient Access and Optimize Revenue: Introducing Model N Formulary Compliance

by Stephanie Cooper Johnson , Model N June 11, 2024

In the dynamic landscape of pharmaceuticals, ensuring formulary compliance is paramount for both revenue optimization and patient access. However, there are persistent challenges with connecting formulary coverage to rebate validation, ensuring access and minimizing revenue leakage. Addressing these challenges head-on, we are thrilled to introduce Model N Formulary Compliance; an integrated data solution designed to transform formulary validation and compliance processes.

Challenges of Ensuring Formulary Compliance

Ensuring formulary compliance presents significant challenges for pharmaceutical manufacturers, as highlighted in our recent State of Revenue Report for 2024. Obstacles to validating compliance in real time include extensive manual effort, limited access to data, and resource constraints.

Historically, manufacturers have heavily relied on backward-looking manual processes to validate formulary plans against contracts and policies, leading to inefficiencies and errors and difficulty with reconciling. Accessing comprehensive formulary data within the workflow of rebate adjudication proves challenging, hindering effective validation efforts and complicating compliance procedures.

Resource constraints exacerbate these challenges, making it difficult for manufacturers to adequately validate all products across all plans. The costs associated with manual processes are substantial, consuming valuable time and resources while leaving room for significant revenue loss.

Manufacturers may leverage third parties for payment audits, but reviews are often only a subset of products at specific intervals, resulting in overpayments and compromised patient access in the interim. This “pay-and-chase” model, characterized by incomplete and inaccurate data coupled with manual processing, leads to substantial revenue leakage, with only a fraction of overpayments being recovered after prolonged settlement processes.

Introducing Model N Formulary Compliance

By executing continuous validations across formularies and products throughout the year, Formulary Compliance eliminates the need to focus solely on high-value plans annually or biannually and solves for the pay-and-chase paradigm. This full-service automated data solution integrates seamlessly with Model N Payer Management and Validata, providing an end-to-end solution for managing payer contracts. Benefits include:

  • Automated Validation: Formulary Compliance automates the validation process across plans, formularies, and products, ensuring comprehensive coverage and accuracy.
  • Real-Time Access to Data: Gain access to real-time formulary data, enabling more accurate and streamlined validations throughout the year.
  • Revenue Protection: Prevent overpayments and decrease time spent on post-payment recovery, significantly reducing revenue leakage.
  • Enhanced Relationships: Strengthen relationships with payers and pharmacy benefits managers by aligning compliance validations with rebate payment cycles and ensuring timely and accurate payments.

With Model N Formulary Compliance, pharmaceutical manufacturers can now navigate the intricate landscape of formulary validation and compliance with confidence. By optimizing revenue, improving patient access, and strengthening relationships with payers and PBMs, Formulary Compliance paves the way for a more efficient and effective pharmaceutical ecosystem.

Schedule a Demonstration Today

Experience the power of Model N Formulary Compliance firsthand. Schedule a demonstration today and embark on a journey towards enhanced formulary compliance, revenue optimization, and improved patient access.

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