How Coopera Enabled End-to-End Pharmaceutical Spending Control in Public Healthcare
Organization
The initiative was led by a regional public health authority tasked with managing administrative and financial oversight across all healthcare providers in the region. The program targeted hundreds of local pharmacies and healthcare organizations, requiring a unified, regulatory-compliant platform to oversee, track, and audit pharmaceutical spending.
This effort supports the broader regional objective of modernizing the Digital Healthcare and ERP ecosystem—specifically, by centralizing tariffing, prescription verification, reimbursement declarations, and payment processes, while integrating with national systems such as Health Card System (TS), SAC (Central Reception System), and the regional health digital platform.
The Challenge
Managing pharmaceutical reimbursements in the public healthcare sector involves navigating a highly regulated and complex ecosystem. Pharmacies must comply with stringent national and regional standards, including the monthly submission of the Reimbursment Request— a formal, structured fiscal document required to receive reimbursement for all dispensed prescriptions.
The system had to manage a full spectrum of challenges:
- Electronic prescriptions (e-Rx) are generated via national systems (TS), and the corresponding dispensing data must be verified, reconciled, and audited at the regional level before payment.
- Each pharmacy is responsible for producing accurate and compliant Reimbursment Request files, aggregating prescriptions, fiscal records, exemption rules, pricing, and adjustments into a validated monthly declaration.
- The lack of real-time tools for prescription validation and anomaly detection often led to manual rework, delays in payments, and disputes between pharmacies and health authorities.
- The regional authority had limited ability to cross-check dispensation data against central and regional systems to detect fraud or misreporting.
- Frequent tariff updates, payback rules, and exemption policies required constant reconfiguration across all local systems, leading to inconsistent application and costly operational errors.
- There was no unified platform for stakeholders (pharmacies, local health units, and regional auditors) to consult records, verify calculations, and monitor deviations at scale.
As demonstrated by Italy’s national e-prescription system—processing over 60 million prescriptions annually with 98% physician adoption—the value of a centralized yet regionally adaptable infrastructure lies in its ability to:
- Reduce fraud and duplication through unique prescription IDs and real-time verification
- Enforce tariff compliance and formulary controls
- Replace manual, paper-based workflows with digital traceability and auditability
The region needed a mission-critical platform to digitalize the entire pharmaceutical reimbursement lifecycle, improve transparency, and ensure strict legal, fiscal, and clinical compliance.
The Solution
To address these challenges, the regional authority adopted Coopera BOAT as the backbone of the regional e-presciption platform, a highly modular and regulation-aware solution that orchestrates the full lifecycle of pharmaceutical reimbursements—from electronic prescription validation to monthly fiscal declarations and pharmacy settlements.
The platform was designed to integrate seamlessly with national infrastructures (TS, SAC) and regional systems (SINFONIA, SIAC), offering full digital continuity across all stakeholders: pharmacies, health authorities, and government agencies.
Key components of the solution include:
- A dedicated DCR management module, enabling pharmacies to generate, submit, and digitally sign their monthly declarations, with full support for correction, review, and audit workflows.
- Real-time acquisition and validation of prescription flows from the TS system, automatically enriched with clinical, pricing, and exemption metadata from national formularies and regional archives.
- A powerful tariffing engine capable of dynamically applying SSN, AIFA, DPC, and payback discount rules across multiple regimes and pricing layers, with daily updates and real-time recalculation.
- Integration with external medicines data providers or formulary updates, and automated ingestion of offline files for continuity.
- Intelligent detection of anomalies through a Rules-Based Engine (RBE) that applies configurable validation rules by ASL and regime, enabling both auto-certification and operator-driven resolution.
- A web-based multi-role dashboard for pharmacies, health authorities, and regional users, allowing full access to prescriptions, controls, DCR statuses, and visual KPIs.
- Secure document and image management modules, archiving scanned prescription images and enabling high-accuracy OCR and classification powered by AI and layout recognition.
- Advanced monitoring and analytics, providing monthly and quarterly reports for pharmaco-economic and pharmaco-epidemiological analysis, and feeding dashboards and external data warehouses (BI).
Built on Coopera’s microservices architecture, the e-prescription ensures:
- Scalability to handle millions of monthly prescription records
- Asynchronous communication to support high-volume, parallel processing
- Security and compliance, including GDPR, eIDAS, and national prescription regulations
- Multitenancy to isolate and configure rules, access, and data by ASL or stakeholder group
- Auditability with end-to-end traceability for every document, transaction, and operator action
This architecture enables not only operational performance but also governance-grade control, making the SUFAR platform a strategic asset in the region’s digital health ecosystem.
Coopera Modules Involved
To support the full digital transformation of internal airport operations, Coopera provided a secure, compliant, and highly orchestrated platform combining content lifecycle management, process automation, and user-centric interfaces.
- Record Management
Long-term compliant archiving of DCRs, fiscal declarations, scanned prescriptions, and pharmacy-generated flows with complete traceability.
- Document Management
Centralized storage and classification of incoming prescription data, receipts, exemption certificates, and validation documents.
- Email Management
Secure integration with certified email channels (PEC), supporting fallback communication and controlled flow of fiscal files and alerts.
- Case Management
Structuring of Reimbursment Requests, anomalies, and pharmacy reimbursement events into digital cases accessible by pharmacies, ASLs, and the region.
- Process Automation
Complete orchestration of the pharmaceutical spending flow—from e-prescription acquisition to Rimbursment validation and accounting alignment.
- Content Lifecycle Automation
Automated retention, legal tagging, and archiving of Reimbursment files, prescription scans, and fiscal flows in accordance with national regulations.
- Intelligent Information Processing
Integration of OCR, barcode recognition, and AI-driven reconciliation between prescription data, pricing catalogs, and pharmacy declarations.
- Coopera Integration HUB
Native interoperability with TS (Tessera Sanitaria), SAC, SINFONIA, SIAC, and pharmacy software via web services and secure protocols.
- Content Analytics
Dashboards and KPIs supporting pharmaco-economic analysis, anomaly trends, flow volumes, and reimbursement history.
Benefits & Results
Coopera provided the digital backbone for the reginal platform that automates the full lifecycle of pharmaceutical expenditure validation—covering e-prescription acquisition, anomaly detection, Reimbursment Request generation, reimbursement control, and compliance with national healthcare systems. The deployment of the regional e-prescription platform has led to a significant transformation in how the region manages pharmaceutical reimbursements and prescription oversight:
- Over 12,000 pharmacies now submit their monthly Reimbursmentdeclarations entirely online, eliminating the need for manual forms, paper archives, and in-person validations.
- More than 100 million prescription records are processed annually through the system, with real-time validation against TS and SAC flows, improving accuracy and reducing administrative disputes.
- The time required to reconcile and approve reimbursements has been reduced by over 60%, ensuring faster payments to pharmacies and greater trust across the supply chain.
- Anomaly detection and rule enforcement are now fully automated, with configurable business rules (RBE) adapted per region and Health Authority, enabling both preventive control and post-facto auditing.
- Pharmacies benefit from real-time access to pricing, exemption, and formulary updates—ensuring accurate application of SSN, AIFA, and DPC rules with zero manual recalibration.
- The platform provides full visibility to ASL and regional health officers through secure dashboards, supporting continuous monitoring, dispute resolution, and strategic planning.
- Through its data analytics and reporting capabilities, SUFAR produces monthly and quarterly regulatory outputs, pharmaco-economic insights, and early warnings on spending trends or inconsistencies.
- Integrated AI services such as OCR and intelligent classification have drastically improved image recognition, data reconciliation, and exception handling, particularly for prescription scans and barcode analysis.
Most importantly, the region now operates under a fully digitized, auditable, and scalable architecture, aligned with national e-prescription strategies and recognized as a benchmark model for future health system modernization.
