Cencora solution

Program management and claims processing

Optimize your affordability programs and break down barriers for patients and dispensing pharmacies.

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Mitigate friction points at the point-of-dispense and keep your products flowing

Affordability programs are crucial initiatives that support patient access to therapy. They are also complex and difficult to manage, involving multiple program partners. This complexity leads to limitations on visibility and the control of cash flow along the way.

Enjoy end-to-end visibility and flexibility of program rules to create more advanced affordability solutions

Our solution adjusts the patient assistance provided — dynamically, on a claim-by-claim basis — working within the pharmacy workflow. Manage payments and claims faster, in one place, and address key barriers, including:

  • Pharmacy under-reimbursement
  • High patient co-pay responsibility
  • 'Insured, but not covered' benefit designs
  • Uninsured patients

Key benefits

Reduce patient friction points

Unpredictable out-of-pocket costs — often related to coverage limits and copays —are friction points that can threaten patient access to therapy. In fact, 49.5% of Americans say they have abandoned medication at a pharmacy due to cost.*

Our claims management solution addresses these gaps dynamically, in real time, by applying targeted discounts at the point-of-dispense.

Better outcomes for independent pharmacies

Consistent under-reimbursement can lead to independent pharmacies making the difficult choice to abandon a therapy. Customers can identify a frequently under-reimbursed prescription and our platform calculates the benefit required to prevent pharmacies from losing money dispensing it — allowing them to continue to provide patients with consistent, trusted access.

Seamless integration

Financial Services uses standard NCPDP claim processing and doesn’t require changes to existing workflows. Instead, it adds a dynamic layer that drives financial transactions in real time according to your established business rules and program requirements.

Make real-time benefit adjustments

Financial Services allows you to provide targeted support for only specific under-reimbursed prescriptions — not a blanket discount applied across all claims.  Provide funds with a dynamically calculated benefit only when an eligible event is verified.
*DrFirst. Half of Consumers Have Abandoned a Prescription at the Pharmacy Because of Cost. 12 April 2022. Accessed 10 March 2025. Available online at: https://drfirst.com/press-releases/why-is-this-still-a-thing-half-of-consumers-have-abandoned-a-prescription-at-the-pharmacy-because-of-cost

Related resources

White paper

4 best practices for biopharma: Advanced strategies to reduce barriers to patient access

Article

Paytech vs. Fintech: Why Healthcare and Pharmaceutical Markets Need Both

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Rethinking financial services in biopharma patient affordability programs
 

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Get in touch to learn about how our financial services solutions can transform your patient support services. Whether you have questions or just need more information, our experts are here to assist you. Together, we can make faster, more reliable care possible.