What You Should Know:
- Kalderos, a data infrastructure and analytics company, identified nearly $1B in inaccurate drug discount requests from 2016-Q1 2023 on its drug discount management platform.
- The report, titled “Mission Critical: Bringing drug discount stakeholders together so patients win,” outlines Kalderos’ vision for a new paradigm of cooperation among drug discount program stakeholders in which everyone benefits — particularly patients.
Rising Costs of Inaccurate Drug Discount Claims
As the Medicaid Drug Rebate Program (MDRP), 340B Drug Pricing Program and other similar programs expand, so do the volume and cost of duplicate discounts and other inaccurate drug discount claims. Across the healthcare industry, outdated technology, inadequate infrastructure and intractable data silos make it difficult to prevent these misapplied discounts, resulting in drug manufacturer overpayment.
In response to this systemwide challenge, Kalderos’ MDRP Discount Monitoring solution analyzes and validates claims data while flagging potential duplicate discounts and other inaccurate claims. Between 2016 and Q1 2023, Kalderos’ MDRP Discount Monitoring solution identified nearly $1 billion in inaccurate discount requests. As Kalderos partners with an increasing number of drug manufacturers to process even bigger data sets, that number continues to grow.
Other findings in the report
- Kalderos identified an average of 5% potentially inaccurate discounts among drug manufacturers, mainly duplicate discounts between Medicaid (MDRP) and 340B (Some assessments identified more than 10% potentially inaccurate claims, some as low as 2%.)
- With Medicaid collecting more than $42 billion in drug manufacturer rebates in 2021, the resulting revenue leakage costs manufacturers billions of dollars each year
- Saw 5% ineligible rebates across commercial programs
“The findings in our third annual report are significant,” said Kalderos CEO Brent Dover. “We urge all stakeholders in drug discount programs to work together on building cooperation and trust. Full transparency and information are mission critical to attaining these goals and enabling our healthcare system to better serve patients.”