A pharmacy benefit built with you, not for you
Most plans inherit a benefit designed for someone else's book of business, then spend years asking permission to change it. PharmPix starts with your population, your risk, and your goals, and builds the benefit around them, because a benefit built for you is where cost containment actually starts.
First we learn your business. Then we build.
We start with your data and your goals: your population's risk, your cost drivers, what your last PBM wouldn't change. Then we design to it. Custom plan designs, carve-outs, preferred vendors: if it's right for your population, we build it.
Every lever, pulled in your favor
Benefit design, formulary position, plan rules: the structural decisions that determine what your plan pays before a single claim is filed. We build them with you, for one outcome: your lowest net cost.
Pharmacy benefit design
Your population, your goals, your cost share and accumulator logic, designed together and built to order. And because we own the platform, it's built in days or weeks, not quarters.
Formulary strategy
Where a drug sits decides what your plan pays. We bring you the net cost math behind every placement, walk through the tradeoffs together, and position for your lowest net cost, not rebate optics.
Plan rules that hold
The quantity limits, refill timing, and step requirements you choose are enforced at adjudication, automatically. What you decide in the room is what happens at the counter.
Network access is easy. Network performance is the difference.
65,000+ pharmacies mean your members can fill anywhere. But access only tells you a claim can happen, not what your plan pays when it does. So we make multiple contracts compete on every prescription.
Evaluated claim by claim
Contracts are evaluated prescription by prescription, not averaged into a blended number. And MAC performance runs above 90 percent.
Your contracts can compete too
If your plan has negotiated its own pharmacy relationships, we layer them into the evaluation alongside ours. The best rate wins, whoever brought it.
Routed for your net cost
We don't own a single pharmacy, so claims route wherever pricing is strongest for that drug. Members never feel it. Plans feel it every month.
When you win, we win
It should never be ‘when you spend more, we make more.’ Our model removes the conflicts built into traditional PBM economics: no spread pricing, no owned pharmacies, claim-level rebate reporting and open to third-party audit. Even the pricing structure is flexible and built with you, so our success tracks your plan's performance.
We show our work
Cost containment is a claim until you can measure it. PharmPix clients get full visibility into plan performance through OneArk: claims detail, utilization trends, rebate tracking, and savings reporting, available when you want it, not just at quarterly review. Then your account team turns that data into the next recommendation, so reporting drives decisions instead of documenting them.
We're already on it
A spike in specialty spend. A new drug hitting your population. A renewal question from your CFO. Every PharmPix client works with a dedicated account team, including a pharmacist assigned to your plan, that monitors performance between reviews and brings savings opportunities forward before you ask. Cost containment is not a report we hand you once a year. It is a relationship we manage every day.
What cost-containment delivers
Biosimilar conversion rate
Achieved through direct outreach to prescribers, pharmacies, and members.
Client trend
Against an industry running 5–7%.
A well-built benefit is one half of cost containment.
The other half is clinical: identifying and addressing risks at the claim level, where drug-related problems and specialty therapies can drive costs that benefit design alone cannot prevent. One half builds the benefit to perform. The other helps ensure it performs as intended. Members and plans benefit from both.
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 what your plan is overpaying for
Most PBMs will reprice your claims. We reprocess them: send us your data and we'll show you how our system would have adjudicated every claim, and what the difference is worth.