Generic Effective Rate (GER) and Brand Effective Rate (BER) recoupment contracts continue to be a major pain point for many independent pharmacies. These effective rate agreements can result in devastating PBM clawbacks but Elevate Provider Network has a very distinct strategy when it comes to GER/BER arrangements that offers protection for our member pharmacies. Through proven mitigation strategies, we have reduced these post-adjudication fees to zero for 2022. That’s right. Elevate Provider Network members owed ZERO in Optum and Caremark GER/BERs for 2022. 

Elevate Provider Network’s innovative bold contracting strategy seeks to avoid whenever possible any agreement with post-adjudication claw backs. For example, Elevate Provider Network bid for a fair reimbursement in the Express Scripts “RFP for Preferred PSAO” model, which ultimately produced large savings for the average Elevate member, amounting to tens of thousands of dollars each year since.

When we aren’t permitted to avoid these agreements, we delay them for as long as possible. This is the tactic we took when we prolonged the implementation of the OptumRx BER/GER. While other PSAOs signed the initial agreement with OptumRx in 2018, Elevate Provider Network continued negotiations for almost a full year. As a result, our members were not subject to the OptumRx BER/GER until 2019, saving our network hundreds of thousands of dollars in that first year.

Finally, when we can no longer avoid or delay, we meticulously manage the BER/GER process with the PBM to make sure our pharmacies pay the least amount possible under the terms of the contract. We don’t simply accept the first overpayment demand presented by the PBMs. Our dedicated contracting team negotiates and validates relentlessly for every dollar, because we know it’s your profitability that’s on the line. Every dollar we can save you is one more valuable dollar you can reinvest back into your pharmacy, so we fight like the stakes couldn’t be higher.

Elevate Provider Network went through a long, arduous reconciliation process to ensure our members weren’t paying a dime more than they had to, and it resulted in the aggregate recoupment amount being zero of OptumRx’s initial demand for overpayment. We were also able to entirely eliminate the Caremark recoupment for 2022 despite initially receiving a demand for overpayment.

Elevate Provider Network is constantly working behind the scenes to protect the financial health of your pharmacy, and our contracting strategy around GER and BER is one of the most crucial ways we contribute to your bottom line