Meghal examines why claims-level transparency has become increasingly important as manufacturers navigate the growing complexity of 340B and other drug pricing programs. He argues that greater visibility into pricing, discounts, and utilization can help manufacturers move beyond compliance to improve gross-to-net (GTN) management, revenue forecasting, and strategic decision-making.
To learn more, watch the webinar: From Program Silos to GTN Transparency: A Unified View with Model N + Truzo.
Read on for Meghal's insights.
Transparency is No Longer a Compliance Issue
By Meghal Patel, Chief Product Officer, Truzo, Model N
Under 340B alone, there were 40 times as many purchases made in 2025 as there were in 2005. Despite that exponential growth and the increased complexity that comes with it regulations around transparency have not kept pace. For all involved, this means more transactions are occurring without any objective view into how pricing and discounts are truly behaving in the market. While 340B is a large portion of the drug pricing dynamics, there are many other overlapping price-setting programs that make the system complex and prone to errors and abuse. Most of these programs are mandatory and necessary for drug manufacturers to get their medicines into the hands of patients in need.
Transparency through data is what ensures 340B and other pricing programs run efficiently and correctly for every party involved — and, ultimately, that patients get access to the therapeutics they need. For manufacturers, there is another reason it matters: without that visibility, confident gross-to-net (GTN) decisions become far harder to make.
The Role of Transparency in Optimizing GTN
For manufacturers, managing GTN is a critical strategic concern, especially as the divide between list prices and net prices continues to widen due to rebates, incentives and other government-imposed price reductions. Organizations must navigate 340B discounts, Medicaid rebates, managed care utilization rebates and a growing set of CMS programs including Maximum Fair Price (MFN), Most Favored Nation (MFN), and more, all of which will keep evolving. Claims-level visibility is increasingly important to optimize revenue and support compliance.
There are growing calls for broad reforms at the government level to mandate claims-level transparency, though many have taken matters into their own hands. More manufacturers are now requiring claims-level reporting from 340B covered entities as part of their program participation requirements. These policies have drawn legal challenges, and multiple federal courts have affirmed manufacturers’ right to require claims-level utilization data as a condition of administering these pricing programs effectively.
With this more robust data in hand, manufacturers are in a stronger position to ensure that they maximize their GTN. Paired with their own purchasing data, dispense-level utilization lets manufacturers match sales against actual utilization and see which pricing program applied – making far more precise revenue forecasting possible. This puts companies in a stronger and more confident position when making decisions around potential investments and spending because they can accurately predict their financials with less hedging around potential revenue leakage, and bring hard data to their pricing and contract negotiations. This also can help with market performance, as they are better equipped to inform investors about how their products are performing in the marketplace. On top of this, it makes it easier for manufacturers to ensure that they are audit-ready and can efficiently comply with government regulators.
Achieving Transparency Through an Intelligence Engine
It should be no surprise, in an era where data is increasingly its own form of currency, that businesses need and expect to have a real, clear and current understanding of how their products are performing.
Claims-level transparency should be a top priority for manufacturers to more efficiently manage their pricing programs. Truzo and Model N together consolidate claims alongside the pricing and discount data already flowing through manufacturers’ systems, delivering a far more granular understanding of how each program is actually operating — the unified source of truth that manufacturers need to remain competitive and confident in their ability to manage GTN.
Pulling from a growing database of more than 100 million verified claims, Truzo enables proactive GTN decision-making by seamlessly marrying its data with Model N’s broader insights across the revenue management cycle.
With this level of intelligence, pharmaceutical leaders can finally craft enterprise strategies based on a clear understanding of what their true GTN looks like. While there is still significant work to be done to ensure that transparency, trust and accountability are at the heart of a system designed to connect people with the medicines they need, having an integrated intelligence engine places today’s pharma leaders on a path to a stronger and more sustainable future.
To learn how pharmaceutical manufacturers are using claims-level intelligence to improve transparency, optimize GTN, and strengthen compliance strategies, Watch this webinar: From Program Silos to GTN Transparency: A Unified View with Model N + Truzo
Sponsored guest posts are bylined articles that are screened by Drug Channels to ensure a topical relevance to our exclusive audience. The content of Sponsored Posts does not necessarily reflect the views of HMP Omnimedia, LLC, Drug Channels Institute, its parent company, or any of its employees. To find out how you can publish a guest post on Drug Channels, please contact Marie Caldwell (mcaldwell@hmpglobal.com).
No comments:
Post a Comment