In more than two decades of working with hospital pharmacies and health systems, one pattern I see consistently is this: organizations are owed money they do not know about.

Drug credits — the refunds and adjustments owed to a health system when medications are returned, recalled, overcharged, or discontinued — accumulate quietly in the background of every pharmacy operation. They are not dramatic. They do not trigger alerts. They do not show up on a dashboard. They just sit there, unclaimed, while the health system continues to pay full price for the next order.

Over the course of a year, those unclaimed credits can add up to hundreds of thousands of dollars. For larger health systems with multiple facilities, the number can be significantly higher. IMC Pharma has recovered more than $2.4 million in credits for our clients — not through any unusual circumstance, but through a disciplined process applied to the same inventory that was already sitting in their pharmacies.

Here is how it works.

The first thing to understand is that unclaimed credits are not the result of negligence. They are the result of complexity.

A hospital pharmacy processes thousands of medication transactions every month across multiple facilities, purchasing channels, and vendor relationships. Credits are generated through a variety of mechanisms — manufacturer recalls, price adjustments, short-dated returns, damaged product, discontinued items, and contract pricing corrections. Each of those mechanisms has its own documentation requirements, timelines, and processing procedures.

The pharmacy team responsible for managing this is also responsible for patient care operations, compliance activity, staffing, and a hundred other priorities. Tracking every potential credit through every vendor's return process, while also managing the daily demands of a busy pharmacy, is genuinely difficult.

The result is that credits get missed. Not because no one cares, but because the process of identifying, documenting, and following up on every eligible return is more than most internal teams can consistently execute alongside everything else they are managing.

Understanding where credits come from helps clarify why they accumulate. The most common sources include:

Manufacturer recalls. When a product is recalled, the manufacturer typically issues a credit for returned units. But the credit is only issued if the return is properly documented and submitted within the recall window. Health systems that do not have a systematic recall-tracking process often miss the window or submit incomplete documentation.

Short-dated and near-expiration returns. Most manufacturers and wholesalers accept returns of medications that are within a defined window of their expiration date, typically six months or less. These returns generate credits, but only if the items are identified, pulled, and submitted before they expire entirely. Once a medication passes its expiration date, the credit opportunity is gone.

Discontinued and overstocked items. When a formulary changes or a purchasing decision results in excess inventory, the overstocked items may be eligible for return credit. But identifying which items qualify, under which vendor agreements, and within which timeframes requires a level of purchasing and contract knowledge that is not always available at the facility level.

Pricing discrepancies. Contract pricing errors — situations where a health system was charged more than their contracted rate — generate credit adjustments. These discrepancies are often small on a per-unit basis but significant in aggregate across a large purchasing volume.

Recovering drug credits is not complicated in concept, but it requires consistent execution across several steps that most internal teams do not have the bandwidth to maintain.

The process starts with a complete inventory review. Every item in the pharmacy — central pharmacy, satellite locations, automated dispensing cabinets, and storage areas — needs to be assessed against current return eligibility criteria. This is not a quick task. It requires someone who knows what to look for, understands the return policies of the relevant manufacturers and wholesalers, and can move through a large inventory systematically.

Once eligible items are identified, they need to be properly documented and packaged for return. Documentation requirements vary by manufacturer and by the reason for return. A recall return requires different documentation than a short-dated return or a pricing adjustment. Errors in documentation are one of the most common reasons credits are denied or delayed.

After submission, credits need to be tracked through the vendor's processing system and reconciled against what was submitted. Credits are not always processed correctly on the first pass. Following up on pending credits, disputing incorrect amounts, and reconciling final payments against expected amounts requires ongoing attention that extends well beyond the initial submission.

Finally, the recovered credits need to be properly recorded in the health system's financial systems. Credits that are not properly reconciled can create accounting discrepancies that create their own downstream problems.

One of the reasons health systems work with IMC Pharma for credit recovery is that we bring an outside perspective to an inventory that the internal team has been looking at for a long time.

When you work in the same pharmacy every day, it is easy to stop seeing what is there. Items that have been sitting in a corner location for months become part of the background. A near-expiration product that has been on the shelf since the last formulary review does not stand out the way it would to someone walking in fresh.

Our teams are trained to look at pharmacy inventory the way an auditor looks at financial records — systematically, with specific criteria in mind, and without the familiarity that can cause internal teams to overlook what is right in front of them.

That outside perspective, combined with deep knowledge of manufacturer return policies, wholesaler agreements, and credit processing procedures, is what allows us to consistently identify and recover credits that internal processes have missed.

A well-executed credit recovery engagement should produce a clear accounting of what was found, what was submitted, and what was recovered. Health systems should expect full documentation of every item returned, every credit submitted, and every payment received.

They should also expect transparency about what was not recovered and why. Not every item in a pharmacy is eligible for return credit. Understanding the boundaries of eligibility — and why certain items did not qualify — is part of the value of a thorough engagement.

The goal is not just to recover the credits from this engagement. It is to leave the health system with a better understanding of where credits accumulate and how to capture more of them going forward. That ongoing improvement is what turns a one-time recovery into a sustained financial benefit.

If your health system has not conducted a systematic credit recovery review in the past twelve months, there is a meaningful probability that you are carrying unclaimed credits in your current inventory. The question is not whether the opportunity exists. It is whether you have the process in place to capture it.