Deal simulation and gross-to-net
Model a contract's net revenue, fees, and Medicaid and 340B exposure before signing; see where a deeper discount stops paying.
Pharma · Biotech · Medtech · Distributors
Know what a contract will cost before you sign it. Pay only what you owe after.
I'm Francis Ruffy. I model the gross-to-net effect of contracts and fix how rebates, chargebacks and fees are processed, inside the systems you already run. AI checks the work; your team signs off on every payment.
Fixed-fee 2-week Assess · No new platform to license · I reply within one business day
Why a 28% discount can lose $1.18M
Sample quarter
What one quarter of channel data shows.
I built a quarter of synthetic channel data for a fictional $500M specialty manufacturer and ran my checks on it. Drag the slider to see rate-based results at your size.
Larchmere Specialty Pharma (fictional)
Not owed, stopped before credit
$1.5M
a year in chargebacks at the wrong GPO price, for sites off the roster or 340B registry, or on expired terms
0.3% of gross · ~1,000 lines a quarter rejected; most rebilled, so only the price difference counts
Revenue within reach
≈$3.5M
a year in net sales from 70 sites already eligible through their GPO but not buying
0.7% of gross, net of discounts
Money not paid out and new revenue are different kinds of value, so I don't add them up. The contract decision below is a third kind.
28%, account view+$212K
28%, first-year net with Medicaid and 340B−$1.18M
26%, first-year net+$512K
Why: at 28%, the contract price sets a new Medicaid Best Price, raising the rebate on every Medicaid unit and lowering the 340B ceiling price on every 340B unit. At 26%, Best Price doesn't move. The difference on one decision: $1.7M. Illustrative, fictional data.
Remaining$96.6M
Given back46.6%
Tap a row for its definition.
Medtech: no government rows; add GPO admin fees, tier rebates and capital-and-consumables bundles. Distributors: it becomes chargeback receivables: claimed, credited and still open.
Bring one rebate program. I'll show you what it's really costing.
Request a 30-minute callThat's the 2-week Assess: fixed fee, scoped in writing.
Updated November 2026 · For drug and biologic manufacturers
The rules changed for 2025–2028. Accruals, invoices and claim checks have to keep up.
Maximum Fair Price
Negotiated prices for 10 Part D drugs took effect January 1, 2026, with 15 more in 2027 and 15, including Part B drugs, in 2028. Manufacturers have 14 days to pay or confirm each refund.
Manufacturer Discount Program
It replaced the Coverage Gap Discount Program in 2025. For specified manufacturers (on low-income-subsidy utilization) and specified small manufacturers, discounts phase in through 2031, and accruals and invoices must track it.
340B rebate pilot
HRSA approved plans from 10 manufacturers for 21 drugs, starting January 1, 2027, with 10 days to pay or deny each claim. Hospital groups sued on October 9, 2026; the same court blocked the first pilot in December 2025. If it proceeds, every claim needs validation in that window.
What I do
Most firms model the deal or process the claims. I do both, and fix the process in between.
Chargebacks, rebates and fees
GPO, IDN, managed-care and wholesaler programs: contract-price loads (845), chargebacks (844/849), 867 tracing, rebate and admin-fee calculations, and GL-tied accruals. Your team signs off on payment.
Includes 40+ life-sciences rebate structures with stacking rules.
GPO roster, membership and 340B eligibility
Effective-dated GPO rosters, tiers, IDN hierarchies and 340B registration: every claim checked against eligibility on the sale date, plus eligible accounts not buying.
Government pricing support
Medicaid (AMP, Best Price, URA), 340B ceiling price, VA FSS, Non-FAMP, FCP, Tricare and Part B ASP: calculations, methodology, restatements and the audit file. You certify and submit.
IRA programs
MDP invoices, phase-in tracking and accruals; MFP effectuation, refund reconciliation and MFP/340B nonduplication; Part B and Part D inflation-rebate accruals.
340B and rebate integrity
Find 340B/Medicaid duplicate discounts and 340B units in commercial and Part D claims; build the file for good-faith resolution, audit and dispute resolution.
Accelerators come prebuilt and run inside the platform you already use. Target time to a first live program: 10 to 14 weeks, set in the Assess scope.
Medicaid, 340B, Tricare, ASP and the IRA apply to drugs and biologics only. Everything else applies to all four segments, medtech and distributors included.
How I use AI
Agents reason. The engine calculates. People sign.
AI agents read contracts, review exceptions and explain why gross-to-net moved. Every number comes from auditable rules. Nothing is paid, posted or signed without your team's sign-off.
- Rules engine Checks and calculates every line Every in-scope line, by auditable rules. The AI never makes up a figure.
- AI agent Reviews every exception Explains each flagged line and proposes a disposition for a person to decide.
- Your team Decides and signs Payments, postings and contracts go out only with a person's sign-off.
Assess · Build · Run
Start with a 2-week, fixed-fee review.
Then keep me on for the build, the period work, or neither.
Four steps, each one paying for the next.
- 1Catch upOne system of record, correct after the fact
- 2RecordClaims checked as they arrive
- 3SimulateFull gross-to-net before you sign
- 4OperateEvery day, in your systems; your team decides
The Assess shows which step you're on and what pays back first.
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01 · Assess · 2 weeks · Fixed fee
Deal-impact and readiness review
What a proposed contract does to net and statutory prices, and what would block a clean close.
You get A deal-impact model, a findings memo and a ranked fix list.
-
02 · Build
Workflows and controls in your systems
I design and build the workflow in your tools, then hand it to your team.
You get Calculation, accrual or eligibility workflows with controls, a test log and a runbook your team can use without me.
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03 · Run · Monthly or quarterly
Rebate, chargeback and integrity operations
Claim validation, disputes and accruals every period. You approve and release payment.
You get Validated claims, a GL-tied accrual roll-forward and a close package auditors can follow.
What the Assess memo looks like
Built on the fictional Larchmere data above.
Sample · fictional data
Findings memo · Larchmere Specialty Pharma (fictional)
2-week Assess · effects at $500M gross
| Finding | Effect | Owner | Fix |
|---|---|---|---|
| Chargebacks at the wrong GPO price, or for sites off the roster or 340B registry | $1.5M a year not owed | Contract operations | Date-effective roster and registry check before credit |
| Proposed 28% contract sets a new Medicaid Best Price | −$1.18M first year; +$512K at 26% | Pricing and government pricing | Best Price check in deal approval |
| 70 sites eligible through their GPO but not buying | ≈$3.5M a year net sales | Field and trade | Target list by GPO and IDN |
Common questions
Who do you work with?
Pricing, contracting, finance, trade and market-access teams at pharma, biotech and medtech manufacturers and at distributors. For medtech: contract pricing, GPO and IDN tiers, admin fees, rebates, chargebacks, accruals and VA FSS (Medicaid, 340B, ASP and the IRA apply to drugs and biologics, not devices). For distributors: contract-price loads, chargeback submission and reconciliation, GPO/IDN eligibility and the EDI 844/849/867 flows with your manufacturers.
Who does the work, and what if you're unavailable at close?
I do. The person who scopes your engagement is the person who delivers it. Run work is built so your team can operate it without me: runbooks, controls and models live in your systems from the start, and nothing depends on access only I have.
How are fees set?
The 2-week Assess is a fixed fee, quoted in writing after our call. Build and Run are scoped in writing from what the Assess finds, before any work starts. I don't publish prices because scope drives them.
What do you need from my team and systems?
For the Assess: the contract terms in scope, a recent period of chargeback and rebate data, and time with the people who run them. Read-only access or extracts are fine.
How do you handle our data?
I work in your environment, on accounts you issue and can revoke, so your data stays under your controls. Client names, figures and materials stay confidential. I'll complete your security questionnaire.
Can you work under our NDA, MSA and vendor onboarding?
Yes. I'll sign your NDA before any data is shared and work through your MSA and vendor onboarding. Beiusis LLC is a one-person firm, so tell me early if your process needs anything beyond that, and I'll say straight away whether I can meet it.
Do you sell software?
No license to buy. Accelerators come with the engagement and run in the platform you already use. If I ever offer something separately, I'll tell you up front, and no engagement will require it.
Contact
Request a 30-minute call
Tell me what you're working on.
- I reply within one business day.
- A 30-minute call about your situation.
- If there's a fit, a written scope and fixed fee for the 2-week Assess.