As healthcare costs continue to climb, self-insured employers are under pressure to find new ways to manage spending without compromising care. While many have implemented pharmacy benefit management (PBM) solutions, a significant opportunity often goes unnoticed: rebates tied to provider-administered medications billed under the medical benefit.
Why Medical Rebates Are Overlooked
PBMs typically focus on pharmacy claims—retail prescriptions dispensed at the pharmacy counter. However they often don’t capture rebates for medications administered by providers in outpatient clinics, infusion centers, or hospitals. These high-cost medications—like IVIG, oncology therapies, and other specialty injectables—are billed under the medical benefit, not the pharmacy benefit.
That’s where VativoRx steps in.
The Rebate Opportunity for Self-Insured Employers
Self-insured employers are responsible for paying their employees’ healthcare claims directly. That means every unclaimed rebate is real money left on the table. As specialty drugs now make up over 50% of total drug spend, overlooking medical rebate opportunities creates a growing financial gap.
Rebates on provider-administered drugs can offer substantial returns—but they require expertise, data validation, and compliance know-how that most PBMs and employers don’t have in-house.
How VativoRx Fills the Gap
VativoRx partners with self-insured employers to identify and recover rebates on the medical side—working alongside their existing PBM or benefit structure, not replacing it.
We provide:
✅ Data segmentation and claims validation to identify eligible medical claims
✅ Compliance oversight and secure submission to manufacturers or aggregators
✅ Therapeutic class-level insights, including areas like Oncology, IVIG, Respiratory, and more
✅ Audit-ready reporting to ensure transparency
All without requiring changes to formularies, billing systems, or provider contracts.
The Bottom Line
Healthcare costs are complex, but the opportunities for savings don’t have to be. By capturing rebates PBMs often overlook, self-insured employers can unlock meaningful financial value while supporting better care delivery.
VativoRx doesn’t replace your PBM—we enhance what they don’t cover. And in today’s cost environment, that missing piece matters.
Want to explore what’s possible? Contact Us!
