Medical Arts Pharmacy is a full-service pharmacy serving the Milledgeville area of southeast Georgia, with a population of about 20,000 people. Tasha Oulsman is the Pharmacy Manager. 

Challenge

During one of the first meetings between Tasha and her business coach, Tasha provided the requested financial reports and the business coach completed a Pharmacy Health Assessment on the business. During this in-depth analysis, the coach uncovered that the pharmacy was being reimbursed less than their contracted rate on about 20% of its prescriptions. This was impacting their bottom-line profit and the pharmacy had an opportunity to correct their pricing strategy and maximize their contracted rate.

Solution

Using detailed reporting and analytics, Tasha’s business coach was able to identify which medications and plans were being impacted. There was also an opportunity to update cash prescription pricing and improve profitability on this line of business that accounted for 15% of their total volume. Together, Tasha and her business coach developed an action plan to optimize pricing, monitor weekly Insite reports, and ensure maximum reimbursement on every claim.

Outcome

The pharmacy team started to monitor weekly reports on reimbursement and worked to correct pricing formulas. They also adjusted their cash prices to stay competitive in their market. Within weeks, the pharmacy saw drastic results. The average profit per prescription increased by $4, as they were now receiving full reimbursement per their contracts with third-party plans. By updating their cash pricing, the average margin on cash prescriptions increased by more than $2 per claim. Tasha and her team now monitor their pricing and suspect claims regularly and adjust them as needed.