Troubleshooting Low or Negative Gross Profits

Generate a Gross Profit by Prescriptionfor the same report period. This report will help identify any prescriptions that have obvious negatives. If you preview the repot, you can sort it by Gross Profit or Markup so that the negatives are at the top of the report and easier to find.

Note: For a period of time with a lot of data (i.e. an entire month), schedule the Gross Profit by Prescription Report to run overnight.

To further investigate the prescriptions, open the prescription in Rx Detail to look at the Requested Cost & Fee window and the Claim Summary.

Check this on the Gross Profit by Prescription Report... What does it mean?
Compare Acq Cost vs. Rx Cost If the Acq Cost is higher than the Rx Cost, the product was potentially sold at a loss. Ideally, Rx Cost should be higher or the same as the Acq Cost.
Are there any large amounts in the Waived Column?

If so, the user may have waived amounts that should have been charged to the patient. For example, perhaps they waived a large cost difference for a prescription where the patient usually pays the difference.

Waived amounts will also be reflected in the Markup columns; the waived amounts are subtracted from the Markup $.
Are there negative markups?

These can be caused by various scenarios:

  • Waived amounts are subtracted from the Markup, therefore large waived amounts may result in a lower markup.
  • Any variable amounts in the Cost calculations. When the variable costs are negative amounts that reduce the prescription’s cost to less than the Acq Cost, the prescription is potentially being sold at a loss.

  • If a drug is priced incorrectly in the Drug file and the cost is changed in Rx Detail instead of in the Drug file, it will cause the gross profit to be skewed and will appear lower than it should be. This results in a "paper" loss because the prescription is submitting for the correct amount, but since the gross profit is based on the Acq Cost in the Drug file, it appears as though the prescription was filled at a loss.

    Example: A drug is incorrectly priced too high (ex. $40 instead of $4) and you manually change the price to a lower cost from Rx Detail (instead of changing the Drug folder), the difference between the Base Cost and the modified cost will be shown in the markup. This will result in a lower gross profit, because the gross profit is calculated from the drug’s acquisition cost at the time of dispensing. Since the drug’s cost was wrong, the gross profit will be skewed and lower than it really should be.