Vitalyze EngineRx

Solutions · MFP Reconciliation

Medicare sets the price. The refund still has to find you.

You buy at list; the manufacturer owes the difference on every eligible fill. Every step of that flow can leak - and most teams are chasing it in spreadsheets. EngineRx tracks expected versus received on every claim, for every pharmacy you run.

LIVE TODAY

Jan 2026: 10 drugs, 38-79% below list

NEXT JANUARY

25 drugs in scope: semaglutide included

THE INFLECTION

2028: Part B reaches hospital infusion

The mandate

Not optional - and it accelerates through 2028.

AUG 2024

First negotiated prices published

38-79% below list across the first ten drugs.

JAN 2026LIVE

MFPs take effect; the MTF moves refunds

Manufacturer refunds due within 14 calendar days of MTF data transmission.

JAN 2027

Cycle 2: 25 drugs live

Semaglutide lands at roughly a $685 per-fill spread; refund pools multiply.

JAN 2028

Part B effectuation begins

Infusion and clinic-administered drugs - Botox, Entyvio, Orencia - reach your revenue cycle. 40 drugs under MFP.

Program facts per CMS, 2024-2026 · once CMS selects a drug, MFP applies to every eligible dispense; refunds flow only through MTF participation.

The mechanics

MFP is a refund, not a lower price. You front the cash on every fill.

01

Acquire & dispense

You buy at WAC. The beneficiary's cost share is based on the MFP.

02

Claim adjudicates

The Part D claim and PDE data flow to CMS as usual.

03

MTF verifies

The MTF confirms eligibility and computes the refund: WAC − MFP.

04

Manufacturer pays

Once the manufacturer approves the claim, the refund is due within 14 calendar days of the MTF data transmission.

05

You reconcile

Cash typically lands 14-28 business days after transmission - for claims you match and track.

Every MFP dispense creates a manufacturer receivable on your books. At health-system scale, that is thousands of claims per month to match against 835 remittances.

The closed loop

From raw MTF data to recovered refunds, automated.

EVERY ICN TRACED FROM ORIGINAL SUBMISSION THROUGH FINAL PAYMENT - REVERSALS AND RE-ADJUDICATIONS INCLUDED

The stakes

See where your refund flow leaks.

Unmanaged, MFP can leak six figures a year - before Part B even lands. Size it against your own footprint.

INTERACTIVE - DRAG THE SLIDERS AND MOVE THE SCALES YOURSELF

7,200

Example: 8 dispensing NPIs × ~75 MFP claims per site per month ≈ 7,200

$300

Cycle-1 spreads per CMS prices; semaglutide joins 2027 at ~$685 per fill

20%

Industry estimate: 20%+ of rebate value left on the table

ANNUAL MANUFACTURER REFUNDS OWED TO YOU

$2.16M

LEAKING EVERY YEAR, UNMANAGED

$432K

Directional estimate, not a quote - sized from your inputs. Every quarter of delay compounds the backlog; recovery gets harder as claims age.

What EngineRx MFP does

A complete refund-reconciliation system for every pharmacy you run.

01 Expected-refund engine Calculates what each dispense should return - per NDC-11, per pharmacy, per day, priced off WAC on the date of service.
02 Remittance matching Ingests 835 remittance data and matches every refund to its claim automatically - reversals, resubmissions, and re-adjudications grouped into one claim history.
03 Variance & dispute management Flags shortfalls, non-payment, and 340B conflicts; assembles the evidence file; runs the inquiry and dispute process with manufacturers and the MTF help desk on CMS templates. The window is short - disputes must be filed within 60 days, and EngineRx tracks that clock on every claim.
04 Enrollment & configuration hygiene Every NPI and NCPDP entity enrolled correctly in the MTF, banking and designations current, new drug lists configured before they go live.
05 System-level rollup One dashboard across every outpatient, retail, and specialty pharmacy you operate - finance-ready reporting that ties refunds to cash.

Commercial model

A flat subscription, capped at the system level.

Predictable and budgetable - no percentage of refunds, no surprise scaling. Catching a single missed refund cycle typically matters more than the line item.

Why now

The baseline you set this year is the one you defend later.

The drug list grows every January. The earlier reconciliation starts, the earlier the baseline is defensible - retroactive cleanup gets harder every quarter.

Keep exploring

The EngineRx platform → Rebate Recovery → 340B Performance → Pharmacy Network Optimization →

Get an MFP exposure snapshot.

Tell us your pharmacy count and Part D volume band. We'll show you what your refund flow should look like - and where systems like yours typically leak.

Schedule an introductory call