Manufacturer Use Case

Verify rebate logic.
Before revenue leaks.

Manufacturer contracts, rebate programs, and access rules are complex and interdependent. We translate that logic into an executable model and verify every transaction against the contract as written.

Contract verification
Eligibility340B, channel, exclusions
Verifying...
ThresholdsMarket share, volume tiers
AccessFormulary, step therapy
CalculationsBase rate, adjustments
100%
Coverage
Real-time
Monitoring
GTN
Protected
4 verification layersFull audit trail
Claim-level
Trace
Every decision

You define the rules. Someone else executes them.

Your contract says
340B exclusion applied
100%
Tier 2 threshold @ 85%
Enforced
Formulary placement
Tier 2
Rebate calculation
Per clause

“The contract is clear. Everyone should follow it.”

Downstream reality
340B exclusion applied
87% — leakage
Tier 2 threshold @ 85%
Triggered @ 82%
Formulary placement
Tier 3 at 12 plans
Rebate calculation
Inconsistent

“We didn't know until the dispute was filed.”

The gap between intent and execution is where revenue leaks.
Most manufacturers don't see it until months — or years — later.
2-5%
Typical GTN leakage
$M+
Per product/year

Three forces make rebate accuracy elusive.

Each challenge compounds the others. Together, they create systematic drift between what contracts say and what systems do.

01

Translation loss

Contract terms pass through multiple systems before execution

Contract
“23% rebate...”
Model
=WAC*0.23
System
0.22drift
Avg. layers3-5

Each handoff introduces interpretation. Small differences accumulate.

02

Amendment velocity

Contracts change faster than systems update

Contract
System
Amendments/year4-8×

New terms get signed before old ones are fully implemented.

03

Discovery lag

Errors compound before anyone knows they exist

Q1
Q2
Q3
Q4
Q1
Q2
Avg. discoveryQ+2

By the time discrepancies surface, recovery windows have closed.

Terms change
Systems drift
Errors compound

From contract clause to verified claim.

We encode your rebate terms as formal logic — not approximations. Every claim traces back to the exact contract language that governs it.

Contract encoding
SECTION 4.2 — REBATE CALCULATION

“Manufacturer shall pay a rebate of 23% of WAC when market share ≥ 85% and product maintains Tier 2 formulary status, excluding 340B-eligible claims.”

encodes to
# Rule: Tier2_Rebate_23
when:
market_share >= 0.85
formulary_tier == "T2"
is_340b == false
then:
rebate_pct = 0.23
Source: Section 4.2, Amendment 3
4 conditions1 output
Claim verification
CLM-84729100002-7510-01
Submitted: $1,247.50Units: 30
340B eligibility
Not 340B§2.1
Market share
87.2%§4.2
Formulary tier
Tier 2§3.1
Rebate rate
23%§4.2
Calculated rebate
$286.93
Verified
Every rule is traceable

Click any result to see the exact contract clause, effective date, and calculation path.

Logic executes identically

No interpretation drift. Same inputs always produce the same outputs.

Amendments update instantly

New contract terms propagate to verification logic without manual re-coding.

The complexity problem

Rebate rules don't exist in isolation.

A single claim can trigger dozens of interacting rules — thresholds, exclusions, tier logic, temporal conditions. Manual verification can't keep up.

Interpretation variance

Same clause, different execution

Contract
exclude_340B: true
PBM A
excluded
PBM B
partial
PBM C
included

Identical language produces three different behaviors. The variance compounds silently.

Threshold sensitivity

Small miss, large swing

0%82% actual85% req100%
18%
below
23%
at threshold

A 3% calculation difference can trigger a 5-point rate swing across all claims.

Access compliance

Paying for placement not received

Contract: Tier 2 placement
T2
T2
T3
T2
T3
T2
T3
T2
T2
T3
T2
T3
T2
T3
T2
T2
T3
T2
18 plans7 non-compliant

Rebate obligations assume access that isn't being delivered.

The math doesn't work.

A typical contract has 47 rules that interact to create 1M+ scenarios. Even checking 1,000 per day would take 3 years — per contract. Manual testing covers less than 0.1% of cases.

0.1%
manual coverage
99.9%
untested
The timing problem

Errors compound in silence.

A single misapplied rule can affect thousands of claims before anyone notices. The question isn't if errors exist — it's when you find them.

Metric
Today
With verification
Error discovery
6-18 months
Errors surface during audits or disputes
Before payment
Issues flagged at transaction time
Transaction coverage
Sampling only
1-5% of claims manually reviewed
100%
Every claim verified against contract
PBM visibility
None until audit
Execution is a black box
Continuous
Real-time view across all channels
Dispute evidence
Reconstructed
Pieced together after the fact
Claim-level trace
Full audit trail from day one
Recovery window
Often closed
Contractual limits expire
Always open
Caught within actionable timeframe
Outcome
Errors compound for quarters
Issues caught before they scale

See it on your contract.

Walk through a rebate scenario using your actual terms. No integration required to get started.

Days to value
100% claim coverage
Full audit trail
Contract Verification
Your contract

"Tier 2 rebate of 23% applies when market share exceeds 85% in the commercial segment..."

Exhibit A, §3.2Effective: Jan 2024
Market share calculation
82.3%
Tier threshold
85%
Applied rebate rate
18%

Tier 1 rate applied incorrectly

Market share below threshold — should be 18%, not 23%

Verified against contract
Full audit trail available