Specialty Pharmacy Calculator

Estimate potential labor savings, recovered denial revenue, and reduced script abandonment for your specialty pharmacy operation.

Your Operation

Total scripts filled per month — type your exact number

fills/mo

Average reimbursement / acquisition value per fill

$

% of specialty drug claims denied (industry: 4–10% typical)

%

Avg minutes spent per script for BI and PA packet setup

min

Loaded hourly cost including benefits

$/hr

% of approved PAs that patients abandon due to delay / drop-off

%
Adjust the assumptions — every factor is editable

The expected case uses the values below. Change anything — the math updates live.

Share of denied revenue prevented or overturned. Conservative: 30%.

%

Share of manual check time removed. Conservative: 50%.

%

Faster turnaround retains this share of abandoned scripts. Conservative: 25%.

%

Share of new referrals / annual renewals requiring BI work. Conservative: 25%.

%

Flat rate, unlimited users

$/yr
Recoverable Value / Year
$56K$77K
Conservative → expected range. Combines recovered revenue and labor savings.

Recovered denial revenue

Assumes 45% of specialty drug claims denied are prevented or overturned. From your 6% denial rate this leaves ~3.3% residual.

$14K
Conservative $9.1K
Show the math
14,400 scripts/yr × 6% denied × $3.5K × 45% = $14K
Conservative: × 30% = $9.1K

Benefit investigation labor saved

Assumes 25% of fills need BI / PA work (new referrals and renewals) and 70% of that time is automated. Conservative: 25% of cases, 50% automated.

$57K
Conservative $41K
Show the math
14,400 fills × 25% need BI × 45 min × 70% × $30/hr = $57K
Conservative: 25% × 50% = $41K

Abandonment revenue retained

Assumes faster PA turnaround saves 25% of scripts currently lost to delays. Conservative: 25%.

$6.3K
Conservative $6.3K
Show the math
14,400 scripts × 5% abandoned × $3.5K × 25% saved = $6.3K
Conservative: × 25% = $6.3K
Net Year 1 · Expected
$17K
Net Year 1 · Conservative
-$4.1K
The conservative case does not cover the $60K/yr cost at this volume. Worth validating with your real denial data before committing.
Aband. At Risk$210K/mo
BI Hours Freed1,890 hrs/yr
FTE Equivalent0.9 FTEs

5-Year Projection

%/yr
5-yr Net (Expected)$149K
5-yr Net (Cons.)$28K
Payback Period~41 weeks
5-yr Value/Cost Ratio1.5x
Loading Chart Data...

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