01 Core Solution

Pharmacy & Medical
Rebate Management

VativoRx manages manufacturer rebates across both pharmacy and medical claims — with the same validation rigor applied to each. For most organizations, pharmacy is reasonably covered. Medical is where the gap is.

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The Challenge

Where Opportunity Gets Lost

Pharmacy benefit rebates are contractually structured through PBM relationships and generally tracked at a detailed level. Most organizations have a reasonable handle on the pharmacy side.

Medical-benefit rebates are a different picture. Drugs billed under the medical benefit — physician-administered therapies, specialty infusion, biologics outside the pharmacy channel — carry real rebate eligibility that most organizations are not capturing consistently.

The leakage tends to cluster around the same sources: disconnects between billing and purchasing systems that leave eligibility unmapped, GPO contract terms applied inconsistently across sites, and claim-level validation that never reaches the detail required to support recovery.

The eligibility rules are more complex, the vendor coverage is patchwork, and the reporting rarely arrives in a format finance can use without additional translation. VativoRx is built to close that gap — without requiring you to change what is already working on the pharmacy side.

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What We Deliver

One Process. Both Benefit Types.

VativoRx applies a consistent, claim-level validation process across both pharmacy and medical claims. The methodology does not change based on which side of the benefit a drug falls on — the same rigor, the same documentation, the same reporting structure applies to both.

For organizations with pharmacy already covered, that means adding medical-benefit visibility without disrupting existing programs. For organizations starting from scratch on both sides, it means one process, one reporting framework, and one partner across the full rebate picture.

Process

Built to Be Explained

Every step in the process produces a record — so when someone asks why a claim was included or excluded, the answer already exists.

Claim-level detail
Across pharmacy and medical — not rolled-up summaries.
Defined validation methodology
Applied consistently, every cycle.
Clear documentation
Behind every eligibility determination.
Reporting structured for three audiences
Finance reconciles it, compliance audits it, operations manages from it — one output set, no custom requests.

Find Out What Your Medical-Benefit Claims Are Missing

A scoped Phase 1 evaluation is the lowest-risk way to answer that question. No PBM disruption, no long-term commitment until you have seen the full picture.

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