Getting a patient to leave the pharmacy with the right prescription drug isn’t as simple as it sounds. If a certain pharmaceutical brand medication isn’t included on that patient's insurance plan formulary, the plan will likely reject the prescription claim. This means the patient may receive a different medication or abandon their prescription altogether. Either way, they’re not getting the medication their physician prescribed, and your pharmaceutical brand could lose market share.
Mitigate the impact of prescription claims denials and boost patient medication adherence
If a claim gets rejected as non-reimbursable for a qualified National Drug Code (NDC), RelayHealth’s Denial Conversion solution converts the rejected claim to a paid response and returns the specified patient co-pay and patient savings notification. The prescription drug gets dispensed as prescribed, aiding in patient medication adherence.
RelayHealth’s Denial Conversion can:
- Improve patient medication accessibility
- Support efficient pharmacy workflow and operations
- Increase patient satisfaction, acquisition and retention
- Give physicians the freedom to prescribe medication that best fits a patient’s needs
Simplify claim denial change with advanced features that include:
- No coordination of benefit (COB) claim required
- Qualified on NDC Code, National Council for Prescription Drug Programs () Reject Code and other parameters
- Government-subsidized plans are automatically excluded