Streamlining Pharmaceutical Claims: Kate Flathers from Kalderos in a Stimulating Conversation with PharmaShots

Shots:

Streamlining claims transactions remains a major challenge for pharmaceutical manufacturers. The financial leakage owing to non-compliant and duplicate claims costs manufacturers a fortune

Using Kalderos' Truzo platform, manufacturers can pay covered entities directly while maintaining transparency and compliance

Kate Flathers, Chief Product Officer at Kalderos, addresses the need for a compliant model for claims settlements without data leakage

Saurabh: Managing payment integrity is critical in the 340B program to mitigate losses for manufacturers and other stakeholders. Can you explain how Kalderos Truzo specifically helps in reducing financial leakage and ensuring accurate payments, thereby mitigating potential losses?

Kate: Truzo establishes a direct connection between pharmaceutical manufacturers and covered entities (CEs), delivering transparency, compliance, and faster payments—all on one platform.

Our platform deploys sophisticated data models and machine learning to proactively manage 340B and other drug discount programs while identifying and resolving potential compliance issues. Truzo allows drug manufacturers and CEs to share a centralized ledger of claims and discount data, providing full transparency for all parties and helping to prevent disputes.

Using Truzo manufacturers can make direct payment to CEs faster and more efficiently while being confident they are paying the correct discounts, thus reducing financial leakage through noncompliant, duplicate claims. For CEs, the primary benefit of Truzo is they get cash discount payments quickly and directly, giving them greater control over program savings and reduction of money lost to fees.

Saurabh: Can you explain how Kalderos Truzo ensures compliance with 340B program regulations? What are some critical compliance features integrated into the system?

Kate: Lack of transparency and visibility into the same data set for all 340B stakeholders is a breeding ground for noncompliance. The transparency and visibility provided by the Truzo platform is designed to proactively ensure compliance with program rules so that there is no accidental misuse.

Truzo utilizes robust data sets from various sources, most notably being able to collect data directly from CEs. These claim-level data sets power core elements of our platform and allow for configurability, such as customer-specific logic and rules, interoperability with existing systems, and data ingestion from existing contracts. Customizing the Truzo platform allows drug discount stakeholders to optimize 340B compliance.

We built compliance into Truzo’s intelligence. By ingesting and matching identifiers down to the claims level, Truzo eliminates the need for retroactive chargeback data, ensuring every eligible claim is paid, and preventing duplicate discounts in real-time.

Saurabh: How does Kalderos Truzo streamline payment transactions compared to traditional methods?

Kate: Truzo’s end-to-end discount management platform is model agnostic, enabling manufacturers to manage both upfront payments and rebates for the 340B program and other government drug discount programs, including the Medicaid Drug Rebate Program (MDRP), commercial programs, and the Inflation Reduction Act’s “maximum fair price” (MFP) mandate.

To streamline payment transactions, Truzo uses a claims-based direct discount model and establishes a direct connection between manufacturers and CEs for claim submission, adjudication, and payment. Instead of purchasing MFP or 340B drugs through wholesalers under a replenishment model, CEs purchase them at the Wholesale Acquisition Cost and then get a discount directly from manufacturers. They receive 340B or MFP benefits as a cash discount within days for each unit dispensed.

This is important in light of MFP, which goes into effect in 2026, as it will introduce a whole new level of complexity to a drug discount system already struggling to cope with a rapid increase in 340B claims. Further, the same types of problems that plague 340B – lack of transparency and inadequate compliance controls – will apply to MFP. It may be difficult to determine whether a claim should be subject to the MFP or a 340B price at the point of dispense—thus underscoring the importance of a direct discount model.

Saurabh: How does Kalderos Truzo enhance financial transparency for healthcare providers and drug manufacturers participating in the 340B program?

Kate: The traditional method of processing and tracking 340B claims is antiquated and not able to scale. Stakeholders use different tools that can’t communicate with each other, leaving data siloed and creating processing delays. This results in a growing backlog of claims, putting even more pressure on an already overburdened process.

Truzo establishes a single source of truth, putting an end to disparate and fragmented data that can lead to confusion and disagreement. With a single source of truth for all claims, stakeholders can manage drug discounts with confidence and clarity and have a detailed data ledger.

The Truzo platform organizes claims data into easy-to-review formats, allowing manufacturers to quickly validate eligibility. Financial transparency facilitates greater trust and cooperation between manufacturers, CEs, and state agencies.

Saurabh: What types of analytics and reporting capabilities does Kalderos Truzo offer? How do these insights benefit healthcare organizations and manufacturers?

Kate: Truzo can be integrated into key data streams and will automatically push back new data to your existing systems. This ongoing and scaled acquisition, ingestion, transformation, and harmonization of data creates a timely, auditable data asset.

A complete unit-level ledger powers analytics on past payments, claim submissions, and CE invoices in one view that helps document compliance and informs strategic decisions.

Algorithms use claims-level data to determine the appropriate program, discount recipient, and discount amount for proactive effectuation — or retroactively identify noncompliance.

Truzo can initiate workflows to resolve invalid discount requests and produce resolution status analytics. The platform also allows customers to continuously monitor rebate statuses and analyze compliance trends through a unified, user-friendly dashboard.

Saurabh: Security and data privacy are crucial in healthcare transactions. How does Kalderos Truzo ensure the security of sensitive payment and compliance data?

Kate: Truzo is committed to the data security and privacy of its users with enterprise-grade certifications. Our cloud-based platform keeps user data secure while seamlessly integrating into existing systems.

Rather than data flowing down a rigid one-way street from one stakeholder to another, our data engine acts like a busy highway interchange where secure, verified, claims-level data can flow and be accessible to the stakeholders who need it, in a format tailored to their needs. Truzo allows manufacturers to pay eligible 340B program discounts directly to CEs via best-in-class industry partnerships that enable secure account-to-account bank transfers without data leakage.

The Kalderos security program is built around SOC 1 and SOC 2 standards and the guidance outlined in ISO 27001 and NIST SP 800-53 frameworks. In addition, all third-party vendors must complete Kalderos’ online vendor security assessment and meet strict security standards. Finally, Kalderos deploys web applications utilizing end-to-end encryption and facilitates key management and rotation via key vault.

Image Source: Canva

About the Author:

Kate Flathers

Kate Flathers is the Chief Product Officer at Kalderos where she leads the strategy of their end-to-end drug discount management platform and solutions. She ensures product innovation, market alignment, and stakeholder satisfaction across solutions in the drug discount management space. Kate has 25 years of diverse product management and development experience. Before Kalderos, she was Head of Product for Hawthorne Effect, an innovative technology platform that brings clinical trials to patients in their homes. Prior to Hawthorne Effect, Flathers was vice president of product for OM1, a health outcomes and technology start-up leveraging big data and AI to help pharmaceutical, life science, and provider stakeholders better understand, compare, and predict patient outcomes.