Built by pharmacists. Working for the member and the plan.
Our pharmacists built these programs around the moments that decide everything: the point of sale, the specialty decision, whether a biosimilar conversion will stick. They know those moments from the counter, where a missed problem reaches a real person, and now from inside claims, where they see what those moments cost a plan.
Clinical programs that pay off, claim by claim
A duplicate therapy no one caught. A specialty fill that cost six figures more than it had to. A biosimilar switch that failed because nobody stayed with the member past day one.
With PharmPix, problems like these get caught before they reach your plan.
Real-time review of every prescription before it's dispensed, catching duplicate therapies, dosing errors, and other risks a single prescriber or pharmacy might miss. OneArk® flags the risk. A pharmacist helps shape what happens next, protecting the member from harm and the plan from a cost it never had to absorb.
90%+ detection accuracy · $2.25 avg PMPM savings
A managed transition to clinically equivalent, lower-cost biologics. OneArk® identifies who's eligible, and pharmacists manage the switch itself, so members stay on therapy and plans capture savings that hold.
75% transition success rate | $1.2M saved in 6 months
A single inappropriate fill can cost more than a year of conventional therapy, which is why avoidable spend gets stopped before it starts.
Clinical Review: Before any specialty prescription is dispensed, PharmPix evaluates whether the therapy is right and whether a clinically equivalent, lower-net-cost option exists.
Once the therapy is confirmed, PharmPix Specialty Solutions work in three connected ways.
1. ACCESS:
Get members to therapy, through the right channel.
Specialty generics
International pharmacy sourcing
2. OPTIMIZE:
Plans pay less. Members stay on therapy.
Best-fit pharmacy routing, matched by drug category
Financial assistance captured
3. MEMBER SUPPORT:
Get members to therapy, through the right channel.
Enrollment and PA handled
One dedicated case manager
A dedicated guide through every step
Members on complex therapy don't fail because the drug was wrong. They fail in the gaps: between prescribers, between fills, between assistance they qualified for and never heard about. A dedicated case manager closes those gaps, from enrollment through adherence.
One coordinator
A single point of contact across prescribers, pharmacies, and fulfillment.
Financial assistance
Manufacturer programs and foundation grants, sourced and applied so plan cost drops too.
Adherence follow-through
Refill monitoring and proactive outreach past the first fill, so members stay on therapy.
Duplicate Alpha-Blocker Therapy Identified Before Patient Harm
Refill activity is monitored past the first fill, so gaps in therapy don't go unnoticed.
Questions about our clinical programs
How they work and what they protect.
Still have questions?
Our clinical team is happy to walk through the specifics for your plan.
Get in TouchThe goal is the right therapy, not fewer claims. Our clinical pharmacy programs target unsafe or wasteful prescribing: duplicate therapies, dosing errors, clinically unnecessary combinations — and a pharmacist reviews every flag in real time, so appropriate therapy moves forward without disruption.
It starts with the plan's coverage decision. Some plans cover GLP-1s for weight management, some limit coverage to diabetes, and PharmPix supports the plan's decision. Where they're covered, utilization is managed through evidence-based prior authorization, real-time monitoring, and case management. Overlapping GLP-1 and DPP-4 use is caught before the claim pays, and oversight continues after approval, so the plan isn't paying for combinations with no clinical value.
A biosimilar conversion is a managed transition from a brand biologic to a clinically equivalent, lower-cost biosimilar. PharmPix identifies eligible members, coordinates prescribers and pharmacies before the change, and monitors adherence and reversion risk afterward.
We don't own pharmacies. Specialty prescriptions are routed across 100+ specialty partners based on the strongest contract and the member's clinical need.
What our clinical programs deliver
Average specialty savings
through specialty hub.
Of flagged alerts
resolved within 24 hours.
PMPM saved
through specialty hub.
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.