We work with healthcare organizations that manage pharmacy and/or medical claims and want a more structured, defensible approach to rebate visibility. This includes:

• Health plans with medical-benefit rebate exposure
• Third-party administrators (TPAs) supporting employer groups
• Hospitals and health systems with inpatient and outpatient drug spend
• Outpatient and infusion providers managing provider-administered drug rebates

Typically 15 to 20 minutes. The goal is to understand your claim environment, current rebate visibility, and whether our process is a good fit. There is no commitment required — if we are not the right solution, we will tell you.

We discuss scope and fit during the discovery phase. Our process is designed to be practical across a range of claim volumes and organizational structures. We will tell you upfront whether your environment is a good match before any engagement is structured.

No. Our initial analysis works from non-PHI, de-identified, or aggregated claim data. We can scope rebate opportunity and validate process fit without requiring EMR access or sensitive patient information upfront.

If PHI handling is needed at a later stage, it follows a documented, HIPAA-aligned protocol.

Yes. Our workflows and data-handling practices are designed to align with HIPAA requirements. We document the data we need, how it is used, and where it is retained throughout the review and reporting process.

We work with standard claims exports — the same structured files your organization already produces. Our data requirements are clearly defined upfront to reduce setup friction. Typical inputs include claim-level pharmacy and/or medical data, drug identifiers, and plan or program context.

We provide a clear specification document before any data exchange begins.

No direct EMR integration is required. We work with structured claims files — no live system connections, no API integrations, and no direct access to your clinical systems.

We perform a structured review of pharmacy and medical claim data to identify claims that may be eligible for manufacturer rebates. This includes evaluating drug classes, NDC codes, plan configurations, and program-specific eligibility criteria.

Every finding is tied to individual claim records — not rolled-up summaries — so results are traceable and defensible.

Claims are evaluated against manufacturer-specific criteria, CMS requirements where applicable, and program-level rules. Our validation methodology is documented and consistently applied across every review cycle — creating an audit trail that supports defensible eligibility decisions.

No. VativoRx is designed to layer onto your existing relationships — including PBM contracts, GPO agreements, and internal reporting workflows. We do not require displacement of current partners to begin, and our process is structured to complement rather than replace what you have in place.

Both. VativoRx manages rebate opportunities across pharmacy and medical claims. Many organizations have visibility into one but not both — we can scope either or both depending on where the opportunity and complexity exists in your environment.

Reporting is structured to give finance, compliance, and operational teams a clear, consistent view of rebate activity. Outputs include claim-level detail, validation status, eligibility summaries, and documentation that supports both internal review and external audit needs.

Reports are delivered on a defined cadence aligned to your organization's review cycle.

Rebate guarantees depend on claim volume, drug mix, and program eligibility — which is why we scope opportunity before making any performance commitments. We can discuss what a structured engagement would look like during the discovery phase once we understand your claim environment.

Reporting cadences and payment schedules are structured to align with manufacturer and program timelines, which typically run quarterly. We provide visibility into expected rebate activity on an ongoing basis so your finance team is not working with surprises at close.

The onboarding process is designed to be low-friction. After the discovery call and initial scoping, most engagements move to a data review within a few weeks. There is no complex integration, no EMR access, and no disruption to current operations.

Timeline varies based on data readiness and internal review cycles on your side.

Minimal. The primary input is a standard claims extract — typically something your data or finance team already produces. We define what we need, when we need it, and in what format. Beyond the initial data transfer, ongoing involvement from your team is limited to reviewing reporting outputs and participating in periodic check-ins.

That's common. In many cases, organizations find gaps in their current rebate coverage — particularly around medical claims, specialty drugs, or multi-vendor environments where reporting is fragmented. VativoRx can work alongside existing vendors.

The discovery process is designed to clarify where those gaps exist — and whether there's a practical case for a structured addition — before any commitment is made.

Yes. Our validation framework is built to accommodate program-specific criteria — including custom formularies, plan configurations, and multi-tier eligibility structures. We document the rules applied in each review cycle so the methodology is transparent and repeatable.