Solutions
Medical rebate management.
The rebates most plans never see? We capture them. Manufacturers offer rebates on specialty drugs billed under the medical benefit, and most of that money goes unclaimed.
What it isMedical Rebate Management is a MaxCare program that collects manufacturer rebates on specialty drugs billed under the medical benefit rather than the pharmacy benefit. MaxCare captures rebates on more than 110 injectable medications spanning 1,750 unique NDCs and handles negotiation, submission and tracking, with NDC-level reporting.
Money left on the medical side of the plan
A standard pharmacy benefit only sees drugs dispensed at a pharmacy. Infusions and injectables given in a clinic or hospital are billed under the medical benefit, and in 2023 that was 36% of specialty drug spend.
Manufacturers offer rebates on many of those drugs, but few organizations have the expertise or qualifications to submit the claims and collect the incentive funds. MaxCare does. The result is a direct cost offset for your plan, without added administrative burden or operational disruption.
Pair it with site-of-care optimization, which moves infusion therapies from hospital outpatient settings to lower-cost settings, and the medical side of specialty spend gets the same scrutiny as the pharmacy side.
Aggregator management
We handle negotiating, qualifying, submitting and tracking, so you don’t have to.
Technology & expertise
Purpose-built technology captures every eligible rebate, including those frequently overlooked.
Payment & forecast reporting
Detailed reports down to the NDC level give you full visibility into rebate earnings.
Transparency & optimization
Clear insights and analytics uncover new rebate opportunities.
Medical rebate FAQ
What is medical rebate management, and how does MaxCare capture medical rebates?
In 2023, 36% of specialty drug spend appeared on medical claims, where manufacturer rebates typically go uncollected because few organizations are qualified to submit them. MaxCare’s Medical Rebate Management captures rebates on more than 110 injectable medications spanning 1,750 unique NDCs and manages negotiation, qualification, submission and tracking end to end, with payment and forecast reporting down to the NDC level.
Why do medical rebates go uncollected?
Rebates on specialty drugs billed under the medical benefit require expertise and qualifications to submit claims and collect incentive funds. Few organizations have both, so the rebates often go untapped.
Does medical rebate management add work for the plan?
No. MaxCare handles negotiating, qualifying, submitting and tracking. It is a direct cost offset for the plan without added administrative burden or operational disruption.
Why does it matter to brokers and TPAs?
For brokers and TPAs, medical rebate management is a differentiator for their clients and a potential new revenue stream for their organization.
Ready to see what transparent pharmacy benefits look like?
Get a no-obligation pharmacy spend analysis and see what MaxCare could save your organization, in plain language and backed by data.