Rebate Monitor is a robust, web-based tool that is part of Pharmaceutical Strategies Group's (PSG) Artemetrx platform, designed to provide independent and continuous oversight of Pharmacy Benefit Manager (PBM) rebate performance. It is specifically built to protect the financial interests of health plans, large employers, and health systems by accelerating the identification and resolution of variances between expected and received rebates.
The software operates by meticulously codifying a client's unique PBM contract terms, conditions, and guarantees into configurable rules. It then applies these rules to monthly pharmacy claims data to project expected rebates.
Key Features and Capabilities
- Independent Rebate Calculation: Provides independent interpretation and calculation of expected rebates by channel, shifting the paradigm from reactive auditing to proactive oversight.
- Near Real-Time Variance Reporting: Offers detailed variance reporting between the projected and actual rebates paid by the PBM, allowing for swift identification of discrepancies down to the claim level.
- Data Ingestion & Updates: Features monthly claims ingestion and projection of expected rebates, with quarterly ingestion of PBM actual data.
- Dashboards and Reports: Provides powerful filtering, drill-downs, and comprehensive dashboards to quickly identify underperforming rebates by channel or formulary.
- Contract Rule Configuration: Transforms complex PBM contract terms into configurable rules applied to actual claims data for precision and accuracy.
- Group-Level Comparison: Enables comprehensive group-level comparisons of expected versus paid rebates, including analysis of plan/group contract terms and guarantees.
Target Users and Use Cases
The primary target users are pharmacy leaders and finance teams within Health Plans, Health Systems, and Large Employers who manage significant pharmacy spend.
Primary Use Cases:
- PBM Rebate Oversight and Validation: Ensuring the PBM is adhering to all contractual rebate guarantees.
- Maximizing Financial Returns: Identifying unpaid rebates and preventing lost interest income by addressing discrepancies early.
- Financial Forecasting: Providing accurate projections of expected rebates based on claims data.