Case Study: Retail Pharmacy achieves $600,000/month cost avoidance with SCIO Health Analytics

Retail Pharmacy - Customer Case Study

Retail Pharmacy, a top PBM, faced a manual, inconsistent and non‑scalable process for reviewing pharmacy claims prior to payment that relied on limited IT resources and produced minimal results and inconsistent edits across clients and lines of business. They engaged SCIO Health Analytics for a concurrent daily review and prescription analytics service to establish a robust, scalable audit and claims‑review program.

SCIO Health Analytics deployed infrastructure and data expertise to process more than 1 million claims daily, developed and ran daily algorithms, completed reporting and auditing, and performed daily outreach to pharmacies to confirm reversals and resubmissions. SCIO’s work delivered roughly $600,000 per month in cost avoidance, uncovered common discrepancies (incorrect days supply, invalid directions, billed quantity different than prescribed) and improved oversight of items such as maximum daily dose, package size, injectables and insulin.