Health systems
Explore claims-level rebate recovery across inpatient, outpatient, and employed physician group drug spend.
Explore health system recoverySelf-Funded Employers & TPAs
Unlock Hidden Drug Rebate Value in Your Medical Claims
Your PBM captures rebates on pharmacy claims. But a significant portion of drug spend — and the rebates attached to it — flows through the medical benefit, entirely outside your current program.
The Challenge
The PBM Captures Pharmacy. The Medical Benefit Is Left Behind.
Self-funded employers and TPAs have invested heavily in pharmacy benefit management — and their PBM programs do capture rebates on drugs dispensed through the pharmacy channel. But when those same drugs are administered by a provider and billed as a medical claim, they fall entirely outside the PBM's scope.
Manufacturer rebates on medical-benefit drug claims exist. They are substantial. And without a dedicated recovery process, they go uncaptured — every quarter, year after year.
A medical-benefit rebate recovery review helps self-funded health plans and third-party administrators understand where provider-administered drug spend creates additional manufacturer rebate opportunities. Claim-level analysis can reveal eligible specialty drugs, biologics, and infusion therapies that are not visible through traditional pharmacy benefit rebate reporting.
For plan sponsors, this creates a more complete view of total drug spend and a stronger approach to pharmacy benefit cost management. For TPAs, it adds a differentiated, data-driven service that complements existing PBM relationships while supporting transparent reporting and fiduciary oversight.
"Most plan sponsors assume their PBM is capturing all available drug rebates. The medical benefit tells a different story."
What We Do
Medical Claims Analysis That Surfaces What Your PBM Misses
01
Medical Claims Audit
We analyze your medical claims data to identify every drug administration billed under the medical benefit — the category your PBM program does not touch.
02
Rebate Opportunity Calculation
We match identified claims against manufacturer rebate programs and calculate the full recoverable value — by drug, by period, by plan.
03
Recovery and Plan Reporting
We execute the recovery and deliver clear reporting to plan sponsors and TPAs — fully documented and aligned with fiduciary standards.
The Veritas Advantage
Additive Value. Zero Disruption. Fiduciary-Grade Reporting.
Performance-only fees
No upfront cost. No retainer. We earn only when you recover — making this a zero-risk engagement for plan sponsors and TPAs.
Complements your existing PBM program
Our process is entirely additive. We target the medical benefit — the channel your PBM does not cover — so there is no overlap and no conflict.
Enhances fiduciary value for plan sponsors
For TPAs, offering medical-benefit rebate recovery is a meaningful differentiator — and a demonstration of fiduciary rigor on behalf of plan sponsors.
Confidential and compliant
All analysis is conducted under a formal engagement agreement. Data handling meets the standards your plan sponsors and compliance teams require.
Explore related recovery solutions
See how medical-benefit recovery applies across organizations
Infusion & specialty providers
Explore rebate recovery for biologics and specialty drugs administered in infusion and specialty settings.
Explore infusion and specialty recoveryBack to drug rebate recovery overview
Return to the Veritas Benefit Partners overview for the full claims-level recovery process.
View the recovery overviewSee What's Left on the Table
A no-cost analysis. No commitment. Just clarity on your recovery opportunity.
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