Clawbacks / DIR Fee’s: The nerve of Insurance companies and PBMs charging back money that was previously paid out to the pharmacy. These fees are a calculated percentage of the ingredient-cost-paid in the claim and the amounts typically vary by plan and pharmacy.
PBMs use one or more metrics to help measure a pharmacy’s performance and provide a minimum and maximum range for a possible fee that can apply to each claim. Depending upon how well your pharmacy scores, your fee will fall somewhere within the minimum and maximum range – really specific, isn’t it?
Many pharmacy owners are left wondering what they can do to manage these fees and properly assess their claims. Datascan Pharmacy Software feature, WinPharm, builds in several utilities to help you not only estimate the clawbacks but also ensure your pharmacy is performing at a 5 star level in order to minimize them. Many pharmacy software companies advertise similar features but WinPharm features are proven to improve patient adherence, boost star ratings, and increase profit margins, making Datascan the best pharmacy software on the market!
Datascan’s DIR estimator is built right into our pharmacy software and allows you to customize individual plans with your contracted high and low-end percentages for 30 and 90-day supplies on brands and generics. As the pharmacy software transmits claims to any plans configured with a fee structure you will see an estimated low and high fee and can estimate your fee will fall somewhere in that range. This utility helps you to evaluate each claim at the time of adjudication instead of waiting to receive an EOB from the PBM several weeks later. This can mean the difference in a positively reimbursed claim vs. a loss, and also alert you to the potential benefit of offering the RX cash to the patient, which you can now do thanks to the new laws signed into place without violating the terms of your agreements.
Patient adherence directly relates to lower clawbacks and DIR fees. Datascan pharmacy software builds in several utilities to help manage your patients with adherence issues. Our one-of-a-kind adherence dashboard, built right into your pharmacy software, offers several customizable reports to hone in on the patients requiring additional services and extra care. Not only can these reports focus on specific patients, but they can also be modified to report on specific drugs with patients having adherence issues, and even be filtered out by pay plan. Datascan pharmacy software also includes several utilities to automatically reach out to patients and doctors to help manage chronic medications. Auto refill and MedSync are included in our pharmacy software and will automatically process prescription refills for patients once it hits a certain utilization threshold. Auto refill will help to make sure your patients are getting their prescriptions refilled on time and help maintain those 5-star ratings for your pharmacy. Using medication synchronization will sync refills up to be processed on the same day each month and can be set to automatically refill prescriptions for your patients.MedSync and auto-refill are two utilities targeting better patient adherence and offered for free in our pharmacy software.
Are you actively communicating with your patients? Text, email, and messages through a mobile application can be extremely effective in working to build better outcomes with patients. These capabilities within the pharmacy software is a must-have nowadays. Most patients prefer the option to receive important texts or emails from your pharmacy. Datascan pharmacy software even offers a free mobile/web refill application so your patients can send requests for refills through an app or online. In your pharmacy software system, you can send alerts to patients to let them know they have prescriptions ready for fill, ready for pickup, are having adherence issues with certain prescriptions, and you can even send custom messages and birthday texts! If you’re afraid that this will take too much time and slow down your workflow – don’t worry! Datascan messaging can be automated through our pharmacy software system.
No longer do pharmacy owners have to sit back and watch the PBMs take money away from them. There are so many ways we can fight back starting with using the technology right within our pharmacy software systems. If you’re currently using Datascan’s pharmacy software system and not taking advantage of any of these great and FREE utilities we encourage you to reach out to our support staff to learn more. If your current pharmacy software does not offer features like these you may want to take a look at what Datascan software can do for you!
