AmerisourceBergen brings fintech to claims processing

Among insurance policies, pharmacy benefit manager (PBM) practices, pharmacy network transactions and—ultimately—the patient’s pocketbook—settling on just how much a drug costs can be a complex and sometimes opaque process. Manufacturers’ copay programs address some of the patient financial issues, but pharmacies can have the same uncertainty when they encounter underpayment from PBMs for the drugs they dispense. When a pharmacy identifies underpayment from a PBM, one reaction can be simply not to fill prescriptions for that drug and that patient’s plan. That, in turn, raises patient frustration and simultaneously limits a drug’s market.

Now, a fintech (financial technology) firm, FirstView Financial, plans to address these concerns through a claims-processing and -adjudication system, ProXe360. As explained by Bob Raffo, FirstView CEO, at the Informa Connect Trade and Channel conference in Philadelphia this week, FirstView can work to resolve this obstacle. Through an arrangement with both the drugmaker and the pharmacy, FirstView can “dynamically price” the drug to make the pharmacy whole through a reduction of the manufacturer’s price. While the drugmaker can lose some revenue, it can still fulfill prescriptions and keep pharmacies, which can be critical in some specialty areas, as allies.

AmerisourceBergen acquired FirstView last August; the logic here is pretty clear: it helps its pharmacy customers, helps move product and embeds itself more deeply in the drug distribution business. “We’re excited to combine our industry leading technology platform with AmerisourceBergen’s portfolio of services and capabilities to expand our reach in the specialty pharmaceutical and provider space, and further advance our shared commitment of expanding patient access to critical therapies,” said Raffo after the acquisition.