PHSI Identifies $3 Million in Opportunities to Improve Gross Margin

IndustryLong Term Care
ProblemA national long term care (LTC) provider was concerned that they were not maximizing third party margins based upon their prescription pricing and operational procedures. They needed outside expertise to provide an independent assessment of their pricing strategies and negotiating tactics with PBMs.
PHSI SolutionPHSI reviewed pharmacy operations and pricing as it pertained to the third party contracts. PHSI developed model contract language for the client to use to maximize reimbursement. We undertook an exhaustive claims analysis to identify opportunities to improve pharmacy margins through changes in procurement, pricing, and staff training. Functional specifications were developed for the client’s IT department to write software code to insert into their proprietary dispensing system to realize the margin opportunities and prevent losses.
ResultsPHSI identified over $3 million in opportunities to improve margins and the client has implemented PHSI’s recommendations to improve profitability.