6M+
Individually acquired, controlled and governed
1.8K+
Pharmacies and healthcare retailers across the region
120+
Across tariffing, accounting and prescription anomalies
98%+
From up to 45 days to results available within hours
1. The Operational Challenge
A major regional public authority governs a healthcare system serving approximately 5.6 million people, with responsibility for healthcare planning, pharmaceutical expenditure control, prescribing appropriateness and coordination across territorial pharmacy services.
Within this environment, approximately 1,800 pharmacies and healthcare retailers participate in a unified regional model together with seven Local Health Authorities, national and regional healthcare systems and the regional accounting environment.
Every month, Coopera acquires and governs more than 6 million dispensed prescriptions. But prescription volume is only the beginning of the operation. A single prescription can contain several medicine packages. Each package must be re-tariffed according to the applicable pharmaceutical regime and evaluated against technical-accounting and prescription controls. The resulting findings can identify discrepancies, generate economic adjustments, require correction or trigger specialist review. Those individual outcomes then need to remain connected to the pharmacy’s monthly reimbursement declaration and ultimately contribute to determining the amount that can legitimately be reimbursed.
Coopera maintains that operational continuity from the individual Prescription through controls and declarations to the approved reimbursement outcome and transfer of validated accounting information to regional SAP.
Financial execution of the resulting payment remains outside this operational scope.
2. Why it was complex
The challenge was not simply processing very high volumes of prescription data. It was turning millions of individual dispensing events into a continuously governed regional reimbursement operation.
Every Prescription has its own operational life
More than six million prescriptions every month must remain individually identifiable and traceable while tariffing, controls, anomalies and potential specialist review occur around them. The volume cannot turn individual business realities into an anonymous batch.
Control happens at an even finer level
One Prescription can contain multiple medicine packages. Each package can require its own tariff calculation and technical-accounting controls, but that does not mean every package needs an independent lifecycle. Its results remain part of the persistent Prescription context.
Control results can change what happens next
More than 120 active controls evaluate tariffing, accounting conditions and prescription anomalies. A result can: Clear the Prescription · Produce an Economic Adjustment · Require Correction · Trigger Specialist Review. Control is therefore not simply reporting. What is discovered changes the operational condition.
Thousands of external participants share the same environment
Approximately 1,800 pharmacies and healthcare retailers participate directly, while seven Local Health Authorities retain review, exception-management and approval responsibilities. A common regional model must therefore preserve both external participation and institutional authority.
Digital and paper evidence coexist
Structured electronic prescription data can coexist with paper prescriptions and images requiring OCR and information extraction. Regardless of source, the resulting evidence must contribute to the same governed business context.
3. How Coopera holds the operation together
The reimbursement operation evolves through three connected Living Business Objects, each representing a different level of the pharmaceutical-financial reality.
Prescription
Every Prescription has its own persistent operational identity. It can keep connected: Dispensing Data · Medicine Packages · Tariffs · Exemptions · Control Results · Adjustments · Anomalies · Supporting Evidence · Review · Final Condition.
The individual medicine packages associated with the Prescription are separately re-tariffed and controlled. But they do not need to become independent Living Business Objects. Their results return to the persistent Prescription and contribute to its current condition.
This distinction is important: the Prescription needs an operational life; its underlying dispensing items need the right governance and context.
More than six million Prescription Living Business Objects every month can therefore remain individually governed while an even larger population of medicine packages is evaluated underneath them.
Pharmacy Reimbursement Statement
Each pharmacy periodically submits a declaration representing the reimbursement it is requesting for the dispensing period. The Pharmacy Reimbursement Statement becomes another persistent business object, connecting: Pharmacy · Reporting Period · Prescription Outcomes · Declared Amounts · Adjustments · Supporting Documentation · Verification · Corrections · Approval Status. It has its own lifecycle of submission, verification, possible correction and approval.
The Statement does not replace the individual Prescriptions. It aggregates their governed outcomes into a higher-level financial context.
Pharmacy Reimbursement Case
The Pharmacy Reimbursement Case represents the operational context required to determine and approve what is actually due to the pharmacy. It can keep connected: Reimbursement Statements · Prescription Outcomes · Adjustments · Exceptions · Specialist Reviews · Approval · Accounting Evidence. The Case persists while the reimbursement amount is resolved and approved. Once the required conditions are satisfied, validated accounting information is transferred to regional SAP.
The three objects therefore represent different but connected responsibilities: Prescription → Reimbursement Statement → Reimbursement Case. Millions of individually governed outcomes progressively become one coherent regional reimbursement operation
4. What This Looks Like in Practice
Package-Level Tariffing and Controls
Fine-grained governance without unnecessary object proliferation.
- Every medicine package associated with a Prescription can be individually re-tariffed according to the applicable pharmaceutical regime.
- Configured rules then evaluate technical-accounting and prescription conditions.
- The package-level result returns to the Prescription rather than creating another disconnected operational lifecycle.
- A discrepancy can produce an economic adjustment.
- An anomaly can require correction.
- Another result may make specialist review necessary.
Control can operate at the finest useful level while the Prescription remains the persistent business object.
From Automated Control to Specialist Review
Automation resolves what it can, judgment remains where required. Most Prescriptions can progress through deterministic controls without manual intervention. Where the current condition requires professional assessment, however, the relevant Prescription can be referred to specialist review — including a Pharmaceutical Committee — while the rest of the population continues automatically.
The specialist does not receive an isolated anomaly. The review occurs with the Prescription, dispensing information, control results and supporting evidence already connected. Its outcome then returns to that same operational context.
Automation handles scale without eliminating professional authority.
External Pharmacies Participate Before Reimbursement Is Final
From retrospective dispute to early correction. Pharmacies and healthcare retailers participate directly through digital services. They can consult relevant prescriptions, review control outcomes, provide supporting documentation and submit their reimbursement declarations. Where paper evidence is required, prescription images can also enter the environment and be interpreted through OCR and information extraction.
This allows many discrepancies to become visible before the reimbursement declaration is finalized. A pharmacy can therefore understand and correct part of the operation while it is still open rather than discovering the problem later through a downstream dispute.
From Millions of Prescriptions to One Accounting Outcome
Individual governance becomes regional financial control. Individual Prescription outcomes contribute to Pharmacy Reimbursement Statements. Statements and their governed adjustments then contribute to Pharmacy Reimbursement Cases. Local Health Authorities retain the authority to review exceptions and approve or reject submissions. Once reimbursement has been determined and approved, validated accounting information is transferred to regional SAP.
The level of aggregation changes. The underlying evidence remains connected.
5. Regional Control at Massive Scale
The same operational model connects approximately 1,800 pharmacies and healthcare retailers with seven Local Health Authorities and regional and national healthcare systems.
More than 6 million prescriptions every month remain individually governed. More than 120 active controls continuously evaluate tariffing, accounting and prescription conditions. Structured digital flows, portal interaction, APIs and paper evidence can all contribute to the operation. The scale is therefore not simply transactional.
The platform must preserve the relationship between millions of individual Prescription outcomes and the progressively more aggregated financial objects they influence. Mass processing remains meaningful because individual operational context is never lost.
6. The Outcome
The regional pharmaceutical-control model has moved from predominantly retrospective verification toward continuous digital control. Previously, monthly tariffing and technical-accounting checks depended heavily on an external verification service and could require up to 45 days after the end of the dispensing period. Today, verification results can become available within hours after transmission closes, representing a 98%+ reduction in the verification cycle. But the transformation is more significant than speed alone. Pharmacies can see control results before reimbursement declarations are finalized, allowing many discrepancies to be corrected while the operation is still active.
A substantial amount of former manual verification has been removed, dependence on the previous outsourced control model has been reduced, and conditions that previously produced downstream reimbursement disputes can increasingly be resolved earlier.
Seven Local Health Authority back offices retain their responsibility for exception handling, specialist review and approval. Once the reimbursement condition has been established, validated accounting information is transferred to regional SAP.
The result is not simply faster pharmaceutical tariffing. It is a continuous regional reimbursement operating model in which millions of prescriptions, package-level controls, external pharmacies, specialist judgment and accounting outcomes remain connected from dispensing evidence to approved reimbursement.
5. What This Case Proves
Persistent operational life can operate at massive scale
More than six million Prescription Living Business Objects every month can remain individually governed and traceable rather than disappearing inside batch processing.
Granular control does not require turning everything into a Living Business Object
Individual medicine packages can be separately tariffed and controlled while their results remain part of the persistent Prescription context.
Multiple Living Business Objects can create one financial reality
Prescriptions, Pharmacy Reimbursement Statements and Pharmacy Reimbursement Cases retain different identities and lifecycles while remaining operationally connected.
Control can determine what happens next
More than 120 active controls can clear a Prescription, create an adjustment, require correction or activate specialist review rather than merely reporting anomalies.
