Clinical decisions come first. Everything else follows.
At PharmPix, clinical oversight helps with utilization management, improve member outcomes, and support more sustainable pharmacy costs over time.
The most expensive claims are the ones that never should have happened
A dose written at twice the recommended strength. Two specialists, two prescriptions, one member caught in between. Drug-related problems like these send more than 1.5 million people to the emergency room every year, and most were preventable if someone had been looking at the right moment.
PharmPix is the PBM that prevents risk before it becomes harm or cost.
Clinical oversight isn't a layer we add. It's how we're built.
At PharmPix, clinical oversight isn't a program layered onto operations. It's how the benefit is designed: pharmacists shaping every decision from formulary to fill, so nothing moves forward unchecked.
Our clinical team guides every part of the benefit:
Formulary and benefit design
P&T committee oversight
Coverage determination and utilization criteria
Specialty and biosimilar strategy
GLP-1 and emerging trend oversight
HyperCare™ point-of-sale safeguards
Member support & provider coordination
The risks a standard claim review can miss
A claim can look routine and still carry risk. At PharmPix clinical protection shapes what moves forward, what gets flagged, and what gets changed, before it becomes cost or harm.
Duplicate therapy
When two drugs, strengths, or formulations overlap when they shouldn’t.
Incorrect dose
When a dose is too high, too low, or inconsistent with safe use.
Drug interactions
When one therapy may reduce the effect of another or increase risk.
Drug-age concerns
When a medication may not be appropriate for a member’s age.
Therapy confusion
When transitions, multiple prescribers, or multiple pharmacies create gaps.
Non-adherence signals
When refill behavior suggests the member may not be taking therapy as intended.
Protection built around real pharmacy problems.
Our clinicians built our clinical programs around real drug-related problems. Every program, from HyperCare™ to Specialty Hub to Biosimilar Conversion, is designed by pharmacists and refined against what they see in claims every day.
An in-house P&T committee that moves fast
Our Pharmacy & Therapeutics committee is in-house, independent, and reviews every new drug within 90 days of launch. Evidence comes first. Formulary placement follows.
In-house, not outsourced
Decisions stay with our clinicians, accountable to your plan and the members behind it.
90-day new drug review
Evidence-based formulary placement made before utilization builds, not after it becomes a trend line.
Clinical protection backed by results
Detection accuracy
across interactions, duplicate therapy, and dosing.
Of flagged alerts
resolved within 24 hours.
Maximum P&T review window
for any new drug.
Clinical protection is one half of cost containment.
The other half is structural: how the benefit itself is designed. Built with each client around their population, not pulled from a template.
Formulary
Plan rules
Network
Pricing model
One half helps identify and address risk at the claim level. The other shapes the benefit to perform. PharmPix brings both together to create the whole pharmacy picture.
The view from inside the benefit
Expert insights from pharmacists and PBM operators with an inside view of where pharmacy decisions break down, what those gaps cost, and how they affect benefit performance.
See the clinical difference on your own book
Send us your claims data and we'll show you what a clinically-led PBM would have caught.