Patient-acquisition spend ran above what reimbursement paid.
Book your audit →

Pharma · Diagnostics

Patient-acquisition spend ran above what reimbursement paid.

This marketing & margin audit identified $71k in wasted annual spend in a Pharma business — evidenced, senior-reviewed, and delivered in 7 days.

$3–8M annual revenue Diagnostics Focus: Reimbursement vs CAC
−$71k
wasted spend cut / yr
22%
above-reimbursement spend (before)
7 days
to findings
Acquisition cost vs reimbursement per test
Before audit
122%
After fix
78%

The business

A diagnostics and lab business ran direct-to-patient acquisition for certain tests, spending on marketing to bring patients in. The tests were reimbursed at set rates, but acquisition and reimbursement were managed by different teams, so whether the cost of acquiring a patient actually stayed below what reimbursement paid was never reconciled per test.

What triggered the audit

Volume grew while margin didn’t, a mismatch that points to acquisition cost outrunning reimbursement. The audit reconciled patient-acquisition cost against the reimbursement received per test, testing whether the marketing spend to bring each patient in was actually covered by what the test paid.

What the audit found

For certain tests, the business was spending more to acquire a patient than reimbursement returned. Because acquisition and reimbursement sat with separate teams, nobody had put the two numbers side by side per test — and when the audit did, several high-volume tests showed a patient-acquisition cost that exceeded their reimbursement rate, so every patient marketed in on those lines lost money. The growth looked like success, which made scaling it feel right, when in fact scaling deepened the loss. Because the two figures lived in different silos, the shortfall was structurally invisible. Reconciled per test, the below-reimbursement acquisition was costing roughly $71k a year.

How we produced this finding

MarginFix reached the reimbursement vs CAC finding by reconciling the pharma books against reality — delivery logs, invoices and contracts side by side — until the gap was undeniable and traced to source, then signed off by a named senior auditor before presentation.

Data sources: Contracts, invoices, billing records and delivery or fulfillment logs — reconciled against each other, so the exact gap behind reimbursement vs CAC is traced to the specific line driving it rather than estimated from the top down.

Key frameworks: Line-by-line ledger and contract reconciliation, unit-economics and cost-to-serve analysis, framed by Forrester Total Economic Impact (TEI) for evidenced business value, cost and risk.

Human validation gate: Every reconciled figure is checked against your own records and signed off by a named senior auditor before it ships — nothing is reported without a human tracing it to source.

Verified against
CRM / rep-call logs Sample-distribution records Territory spend ledger Finance P&L

The wasted spend cut / yr was measured like-for-like over a matched period, reconciled to territory spend in the finance ledger, and signed off by a named senior auditor before publication. Client identity redacted to protect their commercial position.

WORKING PAPER ████████ Diagnostics
Representative Redacted
Acquisition routeCost vs reimbursement
GP-referred
62%
Employer channel
81%
Direct-to-patient
122%
wasted spend cut / yr +$70,840
Recurring — recovered every year the fix holds, not a one-off.
Working paper: acquisition cost vs reimbursement per test traced line by line and reconciled to territory spend in the finance ledger over a matched period. Line items representative and redacted; the recovered figure is the reconciled audit finding.

What we changed

Reconciled patient-acquisition cost against reimbursement per test, exposing exactly which lines were being acquired below what they actually paid.

Capped or cut acquisition spend on the tests whose reimbursement simply can’t cover the cost of bringing a patient in.

Concentrated marketing on the tests where acquisition genuinely clears reimbursement with real margin to spare.

Made acquisition-versus-reimbursement a monitored metric per test, so below-water spend can’t scale unnoticed across the separate acquisition and reimbursement teams the way it had before this was put right.

The result

$71k a year recovered by ensuring patient acquisition stays below what reimbursement pays — a 12× return on the $5,950 Audit + Sprint fee. For any diagnostics or healthcare provider, siloed teams are the trap: acquisition and reimbursement managed separately means nobody sees when the cost to bring a patient in exceeds what the test returns. If you’ve never reconciled the two per test, growth may be deepening a loss. A fixed-fee audit reconciles it in days, before more volume compounds the shortfall.

From kickoff to signed-off findings: 7 days — inside our fixed 5–7 day window.

Reviewed & signed off by:
MarginFix Audit Team
Senior Auditor · MarginFix · 10+ years of auditing experience
Anonymized to protect the client · senior-reviewed findings · Last reviewed
Book your audit → Prefer to talk it through first? Book your audit →