Retaxation – a lucrative instrument for health insurance companies

-Blog post on the subject of retaxation

Retaxations in pharmacies mean that the health insurance companies reclaim money that they have previously paid to pharmacies for the dispensing of medicines. This usually happens up to 15 months after the drug has been dispensed. This is particularly lucrative for health insurance companies, for example in the case of pharmacies that manufacture cytostatics. Cytostatic drugs are chemotherapy drugs that are used to treat cancer. Pharmacies produce these medicines in special laboratories according to the doctor’s instructions and in compliance with strict regulations. This production is always adapted to the individual patient.

With regard to the retaxation of cytostatic drugs, this means that health insurance funds check whether the dispensing and billing of these drugs by pharmacies has been carried out properly and whether all regulations have been complied with. If this is not the case, the health insurance company can demand money back and often uses this simply as a prophylactic measure to reduce the funds. In most cases, this is due to formal errors in the prescription (e.g. pink prescription issued by the doctor) or the billing of wastage (remaining quantities of the medicine required for production).

Retaxations can be very costly and economically ruinous for pharmacies and are often the subject of controversy and discussion between pharmacies and health insurance companies. However, pharmacies often lack the staff, time and expertise to process the mountain of retaxations and to draw up appeals with all the supporting documents in good time.

Strategies for avoiding retaxations

1. Careful documentation: Precise and complete documentation of all processes, from prescribing to dispensing the medication, can help to avoid errors and maintain an overview.
2. Ongoing training: Regular training of pharmacy staff on current regulations and billing practices can help eliminate common sources of error.
3. Proactive communication: A close exchange with doctors and health insurance companies can prevent misunderstandings and clarify problems at an early stage.

This is where we, the Experts Institut, come in with our special retaxation service. Since 2008, we have been supporting pharmacies in taking professional and effective action against unjustified retaxations by health insurance companies. With our expertise and experience, we offer tailor-made solutions that relieve pharmacies of staff and help to minimize economic losses.

Please contact us for further information: info@expertsinstitut.de

Get ahead and in touch with us

Your Experts Institute Team

#pharmacies #retaxation #healthcare #drugs #pharmacy #health insurance #cytostatics #dispensing #billing #pharmaceutical consulting #pharmacy management #healthcare policy #pharmacy practice #drug manufacturing #PharmacistLife

Fabienne Grieger