Physician Administered Drug Rebate Program

WE KNOW WHAT YOU ARE THINKING, BECAUSE EVERYBODY THINKS IT...

“This can’t be true.” It is.

“I think my legal team and administration would know about this.” They don’t.

“We can’t be missing a large bucket of revenue.” You are.

“We already get rebates from our GPO?” Yes, but that is a percentage of bulk purchasing and not manufacturer rebates for physician administered drugs...you may get one, you are eligible for the other.

Why does this rebate opportunity exist?

Pharmacy Benefits Management systems (PBMs) are the the intermediary between the drug manufacturer and the patient. They hold a tremendous amount of influence on the distribution of drugs because they can determine the tier that each drug is on. By being on a higher tier of recommendation than another that drug is much more likely to be distributed than the lower tier drug. In an effort to consistently be recommended in a higher tier and sell more products, manufacturers create rebates to incentivize utilization of their drugs. Any entity that facilitates physician administered drugs is potentially eligible for these rebates.

Those rebates are available based on who actualizes the cost of these drugs. In the case of physician administered drugs, the healthcare organization bears the cost of the drugs and the drug is therefore eligible for a rebate. However, these rebates get lost in translation when facilities charge the insurance companies for a procedure using one of the physician side HCPCS (Healthcare Common Procedure Coding System) Level I CPT (Common Procedure Terminology) or II J codes (drugs administered other than oral and chemotherapy drugs). J codes are not eligible for rebates.

In order to be eligible for a rebate, the drug administered must be registered under the appropriate pharmacy side NDC (National Drug Code) number.

Who is doing this?

In 2005, the federal government told medicaid that they had to take the physician side CPT codes they’d been using and convert them into pharmacy NDC numbers, so states could access the eligible pharmacy rebates. These states received eligible rebates for medicaid patients for more than 15 years.

Why don’t we get the rebate?

Here’s the bottom line: Drug companies don’t pay rebates that are not processed, and your organization does not have the three things needed to process them…

CONTRACTS

Drug manufacturers don't make contracts at the local levels, they make them with the PBM (Pharmacy Benefits Management). 

SOFTWARE TO CONVERT BILLING CODES

This is made difficult because there are often different NDC numbers that could apply so it is impossible to do at scale without. 

A WILLING PARTNER

The health plans have no incentive to help you!

Republic has what you need to unlock your money

WE HAVE THE CONTRACTS

Republic’s PBM was designed to work for you. We have the contracts needed for all of the drug manufacturers. You benefit from all the available rebates at the best rate.

WE HAVE THE CONVERSION CAPABILITY

Our proprietary software converts J codes to the rebate-eligible NDC numbers at scale.

WE ARE YOUR PARTNER

Republic’s incentives align with your goal to produce maximum revenue for your bottom line!

 What you need to do...

30 minutes from your team is all it takes to potentially unlock millions in revenue.

CALL

Schedule a quick call to answer questions and learn how to supply the needed data.

SUBMIT

Together, we set up an NDA and submit a de-identified structured data set to see all the money.