Rivera, the industry’s leading pharmacy payment integrity company, today released the first published industry research dedicated to continuous oversight of pharmacy claims. The state of pharmacy pa...

COLUMBUS, Ohio: Rivera, the industry’s leading pharmacy payment integrity company, today released the first published industry research dedicated to continuous oversight of pharmacy claims. The state of pharmacy payment integrity draws on direct insights from 14 health plans, collectively covering more than 26 million lives across commercial, Medicare, and Medicaid lines of business.
The headline finding: pharmacy claims errors are both frequent and largely undetected. Fifty percent of pharmacy executives surveyed said claims issues occur frequently at their organizations, with another eight percent reporting almost always. The traditional oversight model these plans rely on, a retrospective PBM audit that samples claims 12 to 24 months after they are paid, is not built to catch those issues in time to act on them.
"Pharmacy leaders have known for years where their oversight runs thin. Most could tell us exactly where those gaps sit. What the industry has been missing is a model built to close them at scale," said Ron Hamm, CEO of Rivera. "Pharmacy payment integrity is that model, and the plans that adopt it now will set the standard the rest of the industry will have to meet."
Key findings
Alongside the research, Rivera also released a 13-question pharmacy oversight assessment. The diagnostic lets health plan leaders benchmark their own oversight exposure in under two minutes with no data sharing, vendor onboarding, or internal project lift required.
The full report is available here.
About Rivera
Rivera is an independent pharmacy payment integrity company that helps health plans and employers verify that pharmacy claims are adjudicated according to benefit design, contract terms, and regulatory requirements. Through continuous monitoring of 100% of pharmacy claims, Rivera identifies overpayments, resolves root causes to prevent recurrence, and delivers data that strengthens PBM negotiations. Rivera is not affiliated with any pharmacy benefit manager. Learn more at riverarx.com.
Fonte: Business Wire
Alaa Abdul Nabi, Vice President, Sales International at RSA presents the innovations the vendor brings to Cybertech as part of a passwordless vision for…
G11 Media's SecurityOpenLab magazine rewards excellence in cybersecurity: the best vendors based on user votes
Always keeping an European perspective, Austria has developed a thriving AI ecosystem that now can attract talents and companies from other countries
Successfully completing a Proof of Concept implementation in Athens, the two Italian companies prove that QKD can be easily implemented also in pre-existing…
Circle Internet Group, Inc. (NYSE: CRCL) today announced results for the first quarter of fiscal year 2026. Financial Highlights (Q1’26 vs. Q1’25) USDC…
#AI--Tufin, the leader in network security posture management, today announced new details for Tufinnovate 2026, its annual virtual user conference, including…
Lumentum Holdings Inc. ("Lumentum") today announced that company management is currently scheduled participate in the following investor events: Event:…
$BAH--Booz Allen Hamilton (NYSE: BAH) today announced that former U.S. Army Chief Information Officer Leonel Garciga has joined the company as a Senior…