Gross-to-net rebate reserves rebuilt from source, with a citation on every number the auditor asks about
Every quarter's rebate reserves rebuilt from source, with a citation on every number the auditor asks about.
See one case, screen by screen ↓Every quarter, GTN accounting rebuilds seven reserve programs — commercial PBM rebates, Medicaid, Medicare Part D, 340B, chargebacks, GPO and distributor fees, copay — from ERP sales, 852 and 867 feeds, state invoices, PBM utilization files and a stack of rebate agreements and amendments. One amendment missed, or one utilization share left on a stale average, and the reserve is wrong by millions before anyone has looked at a judgement.
Most of the close is spent compiling, not judging: pulling feeds, re-reading contracts, rolling the reserve forward and tracing each assumption back to where it came from. Then the auditor's request list arrives, and the same evidence is gathered a second time — because the schedule, the memo and the support were never tied together in one place.
Estimated split of close hours per quarter across GTN accounting, the controller and the audit liaison, by hand and with the solution. The totals are the design target of 670 h before and 315 h after.
Six specialist agents read the contracts, fit the payment lags, rebuild and check every reserve, then write the memo and the audit pack; the revenue controller decides and signs.
Northwind Bio is closing Q3 2026. Reserves lock Thursday at 17:00, and the auditor's request list is due the following Wednesday. Here is what the Revenue Controller's day looks like, screen by screen, in the working solution.
Lena opens the Bridge: $6.84B of gross sales stepping down through seven programs to $3.27B of net revenue — gross-to-net of $3.57B, 52.1% of gross. The reserve at Sep 30 is $5.41B and the roll-forward ties to the ledger. 257 of 262 assumptions have a source, 2 of 7 programs are signed, and three variances sit above her threshold.
Decisions for you: “Commercial PBM · +$19.4M — Crestline Amendment 3 raises the exclusive-tier rate from Jul 1.”
Commercial PBM rebates opens on the accrual chain for Crestline Rx, Veltrimab, Exclusive Preferred plans: 91,000 eligible units × $7,120 WAC × 41.0% = $265.7M. The base rebate rate is flagged — the accrual schedule of Oct 5 uses 41.0% from the 2024 agreement, while Amendment No. 3, signed June 24, sets 44.0% from July 1. The amendment's clause 4.2 is open beside it, with the sentence highlighted.
“4.2 Base Rebate. Effective July 1, 2026, for Plans in which the Product is placed on an Exclusive Preferred position, the Base Rebate shall be forty-four percent (44%) of WAC for each Eligible Unit dispensed.”
The trace shows the work behind the number. Feed intake read the 867 resales and claims panel: 91,000 eligible units. The Contract Terms Reader read 14 agreements and 6 amendments and found Amendment 3. The Reserve Builder rebuilt the accrual line by line — 66 assumptions, 64 with a source. The Lag Curve Analyst produced an independent estimate of $1,439.4M from 12 quarters of payments.
Variance Checker: “+$19.4M (1.4%) is above $5M → routed to Lena Ortiz.”
Two options, each with its dollar effect: use the contract rate of 44.0% (+$19.4M to provision) or keep the schedule rate of 41.0% — which needs a reason the auditor can read. She records the contract rate. The Reserve Builder updates the schedule and the roll-forward: the provision is now $1,439.4M, level with the independent estimate.
“Your decision, its reason and the evidence go to the audit trail and to auditor request PBC-03.”
The sign dialog sums it up: Q3 provision $1,439.4M, reserve at Sep 30 $2,646.4M, the independent estimate, her decision, and 64 of 66 assumptions cited. She signs with the meaning recorded — “I reviewed this reserve and its evidence and approve it”.
“Signing locks the program. A later change needs a new version with a reason; both stay in the audit trail.”
Reserve programs shows each provision against its independent estimate, the payment lag and the evidence count. Commercial PBM is signed. Medicaid (+$17.7M) and Medicare Part D (+$11.4M) still need her decision; 340B and other chargebacks agree with their estimates and are ready to sign. The review threshold is the policy's: $5.0M or 2% of the program provision, whichever is lower.
Talmirex's Medicaid share is on the 4-quarter average, 36.4%. Q2 state invoices came in at 38.7% and created a $36.0M true-up, and two states made Talmirex preferred on July 1. The agents recommend 38.0% (+$17.7M) and show the alternatives — 37.5% weighted over three quarters (+$12.1M), or keep 36.4%. The Q2 memo allows a departure from the average for a known formulary change; the choice is hers.
On the Memo tab, “Redraft with agents” reads the signed schedules and rewrites section 4.1 in template RA-12: Amendment No. 3 raised the base rebate from 41% to 44% of WAC; on 91,000 eligible units at $7,120 the provision increases by $19.4M to $1,439.4M, decided by the Revenue Controller on October 7. Sections 4.2 and 4.3 still say they are waiting for her decision — the writer shows pending decisions and never guesses them.
“Before signing, the Memo Writer re-checks every number against its source and the signed schedules.”
PBC-03 — the listing of commercial rebate agreements and amendments effective in Q3 — moves from waiting to ready. Its bundle holds Amendment No. 3 and the contract listing of 14 agreements and 6 amendments, a completeness check against the contract system (20 of 20), the passage the auditor will open, and a drafted response. Priya reads it and sends it to Hartwell & Lane LLP.
Drafted response: “Six amendments were effective in Q3; one changed a rate used in the reserve — Crestline Rx Amendment No. 3, 44% of WAC from July 1. The Controller's decision of October 7 increased the provision by $19.4M; the signed program file is attached.”
The Dashboard tracks what the close is for: prior-period true-up as a share of provision, 0.73% this quarter against a target under 0.5% (Q4 2025: 1.4%); days to signed reserves; where gross-to-net goes by program; payment lag curves — Medicaid 168 days, Commercial PBM 118, Medicare Part D 74; and true-up by program, so a reserve that keeps coming in low shows up.
The same close, seen by the five people who carry it — what their quarter looked like, and what it looks like now.
Six specialist agents read the contracts, fit the payment lags, rebuild and check every reserve, then write the memo and the audit pack; the revenue controller decides and signs.
Reads rebate agreements and amendments and extracts rates, tiers, plans, fees, price protection and effective dates — then compares each term in force during the quarter with the rate used in the accrual schedule.
Fits payment lag curves from 12 quarters of payments and produces an independent run-rate estimate for each program.
Rebuilds each program's accrual from source — units, shares, rates and channel inventory — and keeps the reserve roll-forward.
Compares each schedule with the independent estimate, explains the cause with citations, proposes options with their dollar effect, and routes variances above threshold to the Revenue Controller.
Drafts the reserve memo from template RA-12 with a citation on every number, rewrites only what changed, and re-checks every number against its source before signing.
Answers the auditor's request list with evidence bundles, completeness and accuracy checks on every report used, and a drafted response for the audit liaison.
Decides above threshold, signs. The agents propose; a named person decides.
Ask about any reserve, assumption or auditor request — or say what to change. Every answer cites its source.
Why is the PBM reserve $19.4M higher?
Crestline Rx Amendment No. 3 raised the rebate for Veltrimab on exclusive plans from 41% to 44% of WAC from July 1, but the Q3 schedule still used 41%. On 91,000 eligible units at a WAC of $7,120, the 3.0-point difference is +$19.4M.
Show the Medicaid utilization trend
Talmirex's Medicaid share has risen four quarters running: 34.6%, 35.9%, 36.5%, then 38.7% in Q2 2026. The schedule uses the 4-quarter average, 36.4%. Two states made Talmirex preferred on July 1, so the agent recommends 38.0% (+$17.7M).
Add a rule: send me any estimate with under 12 months of history
Done. Any estimate resting on under 12 months of claims now routes to you, whatever its variance. Today that covers Corventa negotiated-price refunds and the 340B pilot rebates. The rule is on in Settings and in the audit trail.
What is still open before I can sign the memo?
The programs not yet signed, each with what it needs — your decision on the variance, or your signature. After that, redraft the memo so section 4 carries your decisions, then sign it. The waiting auditor requests fill themselves as you sign.
11 screens from the working solution, on its sample data. Pick one to see it large.
Thresholds, approvers and estimation methods are settings — change them and the quarter's schedules are re-checked live.
| Setting | Default | Choose from |
|---|---|---|
| Dollar threshold for review | $5M | Set in $1M steps |
| Percent of program provision | 2% | Set in 0.5-point steps · whichever is lower applies |
| Who decides and signs Commercial PBM and Medicaid | Lena Ortiz | Lena Ortiz · Omar Haddad · Dana Okafor · Priya Raman · Sam Patel |
| Who confirms unit rebate amounts (URA) | Dana Okafor | Lena Ortiz · Omar Haddad · Dana Okafor · Priya Raman · Sam Patel |
| Who sends auditor responses | Priya Raman | Lena Ortiz · Omar Haddad · Dana Okafor · Priya Raman · Sam Patel |
| Medicaid utilization method | 4-quarter average | 4-quarter average · Weighted last 3 quarters · Latest 2 quarters |
| Lag curve history | 12 quarters | 8 · 12 · 16 quarters |
| Short-history constraint | On | Book the higher end of the range when history is under 12 months |
Every figure is labelled: a target the solution is built to, an estimate, a typical published result, or a proven one.
“demo” = seen in the working solution, on its sample quarter-end data · “target” = the design goal, measured in the live solution · “estimated” = our estimate of where the close hours go. People and companies named on this page are characters in the working solution.
It is the quarter's rebate and chargeback reserves with their support attached: a schedule for each program, a reserve memo with a citation on every number, a true-up analysis and the answers to the auditor's request list. Here the agents rebuild each program from source and the Revenue Controller decides and signs.
In the working solution, seven: commercial PBM rebates, Medicaid rebates, Medicare Part D, 340B discounts, other chargebacks (FSS/VA, GPO), GPO and distributor fees, and copay assistance. Each has its own accrual chain, lag and evidence.
The Reserve Builder rebuilds the accrual from source — units, share, rate and channel inventory — and the Lag Curve Analyst makes an independent estimate from 12 quarters of payments. The Variance Checker compares the two, explains the cause with citations and sends anything above the threshold to the controller.
That is one of its rules: compare every contract amendment effective in the quarter with the schedule. In the working solution it found that Crestline Rx Amendment No. 3 set 44% of WAC from July 1 while the schedule still used 41% — a $19.4M difference.
Yes. The agents propose options with their dollar effect and never decide a judgement. The Revenue Controller chooses, a reason is required to keep a schedule value, and each program and the memo are signed with the meaning of the signature recorded. Signed programs are locked.
Each request is matched to its evidence, every report used is checked for completeness and accuracy, and a response is drafted. Requests tied to a program fill themselves once that program is signed, and the audit liaison decides what to send.
Yes. The dollar and percent thresholds, who decides and signs each group of programs, the Medicaid utilization method, the lag curve history and the short-history constraint are all settings. The quarter's schedules are re-checked when you change them.
The Agentic Solution Engine builds and deploys it from your requirements and documents — your reserve policy, memo template, agreements and a past quarter's feeds — and it goes live once every quality gate has passed. We will walk you through it on one of your own quarters first.
Every study's quarter-end accrual built from contracts, activity and invoices, with the evidence for every line.
1-min filmMedicaid RebatesEvery state invoice checked line by line, every dispute backed by the claim rows behind it.
1-min filmAlliance StatementsEvery partner’s quarterly profit-share statement built from the ledger and the agreement, each number traced to its clause.
1-min filmWe’ll rebuild a past quarter of your gross-to-net reserves from your own contracts and feeds.