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The Reimbursement Alert Will Save You Money!
PharmSaver’s Reimbursement Alert feature is something truly unique to our site that is available to pharmacies when they choose to use Purchase Order (PO) upload. We will compare your pharmacy's dead net pricing to MAC data and run a prospective negative margin report. We can let you know before purchase if there are items in your cart, that based on the price, you are thinking of purchasing them at, will result in a negative reimbursement after adjudicating a claim. We will even take it a step further than that, if we find a negative reimbursed item, we can look at those items in our vendor files and see if we can find them at prices low enough to change that negative reimbursement into a positive one.
When it comes to the reimbursement piece, your pharmacy has the option of running your pricing up against state-level MAC, PDP-level MAC, or Commercial MAC. We generally recommend sticking with Commercial MAC because it is the most aggressive, so it will raise the most red flags for your pharmacy. If you find that you are processing claims mostly for Medicaid or Medicare you may choose to use the other MAC levels.
This reimbursement icon will show up on the cart screen underneath the name of the drug to which it applies. A green "Reimb Saver" icon means this item is a positively reimbursed item and a red "Reimb Alert" means this item is a negatively reimbursed item. Green "Reimb Saver" icons indicate the item at the primary vendor price, based on our MAC data, was coming up as a negatively reimbursed item. But we were able to find it at a price low enough from one of our vendors, to change that negative reimbursement into a positive reimbursement.
