Detect Pharmacy Copay Misuse Before It Erodes GTN

Pharmaceutical manufacturers already know their affordability dollars are under pressure. What far fewer realize is how much of that pressure comes from a single, quiet source: the way copay claims are processed at the pharmacy counter. This webinar will explore how pharmacy-level copay misprocessing creates hidden gross-to-net (GTN) leakage and how manufacturers can identify, address and reduce that exposure.

Many organizations identify obvious warning signs, but they often miss the thousands of smaller manipulations that compound month over month into billions of dollars in industry-wide leakage. Roughly one in ten pharmacies engages in some form of copay misprocessing, and the exposure is almost always larger than manufacturers expect.

This session moves past the theory and into the mechanics. Drawing on frontline pharmacy experience and hundreds of thousands of audited claims, the featured speakers will walk through exactly how misprocessing happens – from covered-claim markups to coverage-code and rejection-code switching – and why these behaviors accelerate as reimbursement pressure on pharmacies intensifies. They’ll also examine why the newest wave of self-pay and direct-to-patient purchasing channels widens the same exposure, and why automated, pre-payment flagging alone consistently falls short against a problem that is fundamentally operational and human. Finally, the discussion will show what actually changes pharmacy behavior. A combination of real-time claim analysis and PharmD-led intervention is what turns detection into recovered dollars.

Attendees will leave understanding where copay leakage originates, why traditional retrospective audits fail to stop it and how manufacturers can protect GTN performance while keeping affordability programs working the way they were designed to – reaching the right patient, at the right time.

Register for this webinar to learn how pharmacy copay oversight can uncover misuse, recover affordability spending and strengthen GTN performance.

Speakers

Gerard Rivera, Co-Founder & CEO, RIS Rx

Gerard serves as CEO of RIS Rx, which he co-founded in 2020. In partnership with the RIS Rx executive team, Gerard is pioneering gross-to-net (GTN) revenue protection with direct impact to millions of patients and the pharmaceutical manufacturers that support them. His background spans frontline pharmacy, patient access & affordability operations, with leadership experience across multiple pharmacy services and healthcare organizations. He earned his PharmD from Loma Linda University.

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Stephen Hom, Co-Founder EVP & COO, RIS Rx

Stephen Hom, PharmD, serves as Chief Operating Officer of RIS Rx, which he co-founded in 2020. Stephen manages all aspects of operations in RIS Rx’s patient affordability, benefit design and gross-to-net (GTN) revenue protection solutions for pharma manufacturers, routinely combining his deep knowledge as a frontline Pharmacist with scalable tech-enabled workflows to support the lives of millions of patients. He earned his PharmD from Loma Linda University.

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