Pricing Model
Here is exactly how we make money.
Most vendors in hospice pharmacy would rather you not ask this question, because the answer quietly tilts every recommendation you receive. We would rather answer it on a public webpage. Ask anyone else to do the same.
The Conflict of Interest
Your vendor's pricing model is in the room for every decision.
When a vendor's revenue rides inside the claims, everything tilts toward more: more claims processed, shorter fills that multiply them, a wider list so fewer fills ever stop. When the revenue is a flat per-diem, everything tilts toward less. Neither tilt was chosen by your clinical team, and both arrive disguised as advice.
Our fee does not touch the claim, so there is no tilt to disguise. Here is where the difference shows up.
Days supply
Keeping a stable patient on 14-day fills when a 30-day fill is appropriate doubles the claims, and the margin with them, while your hospice pays for the extra deliveries and dispensing. Under our model, fill cadence is a clinical decision, because we earn the same either way.
Claim volume
Refill cadence, auto-fill defaults, comfort kit composition: every operational setting can be tuned to produce claims. Ours are tuned to produce appropriate care, the only outcome we get paid for.
Formulary width
Narrowed until the per diem covers less than your patients need, or widened until every fill carries margin. Animated below, because this one deserves to be watched.
The advice itself
When the consultant's employer profits from the answer, consultation becomes a sales channel. You pay for ours directly, so it has exactly one direction to point: yours.
One lever, animated: the same hospice formulary under all three models.
The per-diem model
The list shrinks
Paid a flat rate, so every covered med is their cost.
3 medications moved to separate charges. The quote never changed.
The MerlinRx model
The list fits
Paid a visible fee, so we have no position on your list.
Year 2 · Added glycopyrrolate · terminal secretions, IDG request
Year 3 · Removed duplicate antiemetic · clinical review
2 changes in three years. Both clinical, both documented, both yours.
The spread / claim-based model
The list grows
Paid inside each claim, so every fill carries their margin.
4 medications waved on. Fewer stops, more claims, and your per-patient-day pays for all of it.
Two opposite distortions, one cause: the vendor's revenue touches the claim. One model profits by narrowing your formulary until the per diem covers less than your patients need. The other profits by widening it until your spend covers more than they do. MerlinRx is paid a fee that does not move either way, so our only job is helping you build the formulary your census actually needs.Medications and figures illustrative.
Follow One Claim
The invoice is the proof.
Pass-through pricing is a claim every vendor can type. It is also a claim your invoice can verify, line by line, if your vendor lets it. Ours does: the rate the pharmacy was paid and the rate you were charged are the same number, printed on the same page.
No spread between them. Ever. And our fee stands in its own labeled line, where a fee belongs.
Pharmacy contract rate
Morphine Sulfate 20 mg/mL oral solution · 15 mL · 14-day supply
Your invoice line
Same fill, same line item, same month
Kept by MerlinRx inside the claim
$0.00Our fee appears as its own visible line, billed per patient day: platform, data analysis, and consultation. It never hides inside a claim, and the rate the pharmacy was paid is on the page in front of you. An illustration.
One fee. One pass-through. Nothing hidden between them.
Our fee is a price per patient day, customized to your census, your sites, and your situation, so it scales with the size of your program and nothing else. We make money when the platform and our guidance deliver value, not when your pharmacy spend grows. That single design choice is why our recommendations can always point in your direction.
What you pay us for
- ✓The Merlin platform: ePrescribing, claims, formulary, prior authorization, reporting
- ✓Data analysis that turns your utilization into decisions
- ✓Consultation from people who have implemented hospice pharmacy for a decade
- ✓Billed as a price per patient day, customized to your census and situation
What passes through untouched
- ✓Every pharmacy claim, at the contracted rate
- ✓The invoice shows what the pharmacy was actually paid
- ✓Every line item visible and auditable, every month
What does not exist here
- ✕Spread pricing between what you pay and what the pharmacy receives
- ✕Rebate arrangements that steer your formulary
- ✕Markup on the medications your patients need
The Bet We Make
Our tools and guidance should save you more than we cost.
That is the entire business model: top-tier software, data analysis, and consultation that let your hospice operate its pharmacy benefit in the most cost-effective way possible. Formulary-appropriate prescribing at the point of care, clean claims, prevented rejections, and visibility that arrives in time to act on it.
It starts with the formulary itself. We help you build the list your census actually needs, and because our fee does not move when the list does, the only interest at that table is yours.
We measure it, too. Baseline metrics before go-live, the same numbers after, monthly summaries to your managers, and no long-term lock-in. If the math stops working for you, you are free to go. That is what keeps the math working for us.
The money questions, answered directly.
How does MerlinRx charge?
We charge a price-per-patient-day fee for the software, data analysis, and consultation, customized to your census, your sites, and your situation in the contract. The fee is visible and predictable, and it scales with your census rather than your drug spend. Pharmacy claims are separate: they pass through at the contracted rate without markup, and your invoice shows what the pharmacy was paid.
Does MerlinRx make money on medications?
No. We do not own pharmacies, we do not mark up medications, we do not retain rebates, and there is no spread between what you pay and what the pharmacy receives. Our revenue comes from the software and services fee, full stop.
What is spread pricing, and why does it matter in hospice?
Spread pricing is the gap between what a vendor charges the hospice and what it reimburses the pharmacy, kept as hidden margin inside each claim. Because every fill carries margin, claim-based vendors also have a quiet incentive to widen your formulary: fewer stops, more claims, more revenue, all paid out of your bottom line. Pass-through pricing removes both the hidden margin and the incentive behind it.
What is the catch with per-diem pharmacy pricing?
A per-diem vendor charges a flat rate per patient day that covers the medications on its own formulary. Every covered med is their cost, so the incentive is to narrow that list over time: the quote stays the same while more medications fall off it and come back as separate charges. If you are evaluating a per-diem arrangement, ask for the formulary change history over the life of the contract.
Why would a pricing model affect days supply or refill patterns?
In a claim-based model, every fill is a revenue event. Holding a stable patient at 14-day supplies when a 30-day supply is appropriate doubles the claims from the same medication, along with the deliveries and dispensing costs your hospice absorbs. Operational defaults like refill cadence and auto-fill settings can quietly do the same. Under a fee model, none of that moves our revenue, so fill decisions stay where they belong: with your clinical team and your pharmacies.
Why not just publish the rate?
The model is public: a price-per-patient-day fee. The rate is customized, because a 40-census single-site hospice and a 300-census multi-state operator are not buying the same engagement, and a number without that context would be a guess. What we will do is quote your rate plainly in the first conversation, with the structure on one page and nothing contingent buried in an exhibit.
What if MerlinRx does not save us more than it costs?
Then we have not earned the relationship. Before go-live we establish baseline performance metrics; after go-live we measure the same numbers and send monthly summaries to your managers. There is no long-term lock-in. If the value is not there, the data will show it, and you can leave.
Get the number, plainly.
A short discovery call is enough to quote the fee for your census and configuration, with the structure on one page.
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