CostCheck Medicare Margin Optimizer

MEDICARE REVENUE OPTIMIZER

View the Complete Financial Picture for Every Purchase

Outpatient volumes are growing faster than reimbursement rates. Meanwhile, purchasing lower-cost therapeutic alternatives – such as specialty medications and biosimilars – isn't always the best option for your bottom line. Two comparable products can have a margin difference of $2,000 per vial – but if you're buying on cost alone, you'd never know it.

CostCheck closes that gap with the new Medicare Revenue Optimizer. It layers Medicare Part B reimbursement data directly into the Recommended Changes workflow, so every alert shows both cost and revenue impact side-by-side.

Margin Visibility at the Point of Decision

See cost impact, profit impact, and estimated margin impact for every recommended change – directly in your decision-making workflow.

Built for Specialty and Biosimilar Drugs

High-cost specialty drugs and biosimilars are now grouped for cross-product margin comparison, making per-vial differences visible for the first time.

A Foundation for Your Claims Data

Start with directional Medicare reimbursements today, then connect your own claims data (coming in 2026) for exact, payer-level profit calculations.

Cost Savings, Revenue Opportunities, and Double Wins

Recommended Changes now surfaces three types of opportunity:

Cost savings, from switching to a cheaper equivalent
Revenue opportunities, where the alternative drug reimburses at a higher rate
Double wins, where a single switch lowers your acquisition cost and raises your reimbursement at the same time.

Every opportunity type, ranked side by side

Built for Outpatient Drug Intelligence

CostCheck now maintains biosimilar mappings across drugs that are therapeutically equivalent and ingests specialty distribution contracts – so you can make the right decisions on your highest-cost drugs. Every reimbursable drug is linked to its Medicare billing code, connecting each purchasing decision to its maximum reimbursable amount under fee-for-service Medicare Part B.

Comparisons that go beyond generic equivalence

A Directional Signal You Control

CostCheck estimates potential reimbursement by assuming purchased units are billed and reimbursed at 100% – a directional, high-value signal. A toggle lets you include or exclude the estimated reimbursement from any comparison, so you can evaluate cost alone or the full revenue picture.

Toggle margin insights on or off

Don't Settle for Medicare ASP Data Without the Workflow

Presenting reimbursement data outside of the decision-making workflow is less than helpful.

CostCheck delivers the signals and workflow together: cost savings, revenue opportunities, and margin visibility, calculated side by side and rolled into a single financial impact number on your savings dashboard.

These are numbers that pharmacy teams can use to demonstrate their true financial impact on the health system.