The independent pharmacy family focuses on patient care and their immediate community. This is what drives you, as a pharmacist or technician, to work furiously around the clock to meet patient and community needs. However, the fact remains that several community pharmacies are forced to close their doors because they can no longer make ends meet due to low reimbursement.
As you watch out for your community, who’s watching out for your bottom line?
Average Wholesale Price (AWP) resubmissions are an excellent way to collect money that you may otherwise be leaving on the table. In essence, an AWP resubmission is money that you can receive on a prescription that has already been dispensed and after the PBM has evaluated and updated the reimbursement amount for a medication within a billable window, usually around 30 days.
If you’re interested in collecting more money for prescriptions with AWP resubmissions, here are six things you need to know.
AWP Resubmission Services
To resubmit claims on your own would require a lot of monitoring on your part, enough that the money you make may not be worth all the time that you spend looking for resubmission opportunities.
The good news is that there are services that can help you find resubmission opportunities or even resubmit a claim for you. These services may be provided by your wholesaler, pharmacy software partner or a third-party company.
These services usually cost a monthly fee. You should take this into account when looking at how much money you’re gaining from resubmission opportunities.
Times for Resubmission
Resubmissions are most likely to bring you profit twice a year, when insurance companies update their AWPs. This occurs December through January and July through August. You will still receive AWP resubmission opportunities throughout the rest of the year. These months are just when you have the best opportunity for additional reimbursement.
Pharmacy Software Updates
Third-party or wholesaler AWP resubmission services that aren’t connected to your pharmacy software may not update in your pharmacy software. This will cause discrepancies in your software with your insurance balances and reports.
To remedy this you will need to manually update the balances after you receive your resubmission reports. Also, you may check with your software provider to see if they offer a service that can handle this for you.
Not All Plans Apply
This normally occurs with providers like Medicare or Medicaid. Sometimes they’ll update their AWPs to reimburse more for a medication. However, this reimbursement only applies from that time on. Therefore, you will not receive any additional reimbursement for resubmitted claims.
Losing Money on Resubmissions
Once you reverse and resubmit a claim, you can’t undo it. So if you resubmit a claim that ends up losing you money, you have to deal with that loss.
The best thing you can do is to take caution during the first quarter, when people are working on meeting their insurance deductible for their insurance. Sometimes, when the deductible is met the insurance benefits change and the PBM ends up paying less.
Just like when you originally send a claim, you will pay switching fees for each resubmission claim, one for the reversal and one for the resubmission. Sometimes the reversal is only a fraction of the cost of a normal switching fee, which on average is from 10 to 30 cents per transmission.
Whether you choose to look for opportunities yourself or hire a service to do it for you, collecting additional funds from AWP resubmission can help in keeping your pharmacy doors open and your focus on your patients and community.
If you’re interested in learning about more ways you can be collecting all the money available to you, I encourage you to look into our service, Profit Watch Plus.