FAQs

Most PBMs manage pharmacy in pieces: pricing in one place, clinical review in another, member support somewhere else. PharmPix was built to see the whole pharmacy picture, connecting clinical strategy, cost containment, technology, and member support in one model. That's what lets us act at the moment of risk, before a claim is paid, instead of catching problems after the fact. We're independent and clinician-led, we don't own pharmacies, and our pricing is built to remove conflicts of interest.

In a traditional model, the PBM can profit from spread pricing, retained rebates, and pharmacy ownership, which means its incentives don't always match the plan's. In a pass-through model, pricing and rebates flow to the client and the PBM earns a clear administrative fee. PharmPix goes a step further: pass-through economics plus clinical oversight across the whole benefit, not just the price.

Look past the discount guarantee. Ask how the PBM manages specialty and GLP-1 exposure, whether clinical decisions happen before or after claims are paid, how rebates and pricing are reported, and whether you can see and validate what's actually driving your spend. If a PBM can't show you where cost and risk are sitting in your benefit, that's the answer.

As a sequence of decisions, not a single contract. Every specialty prescription is really a series of choices: the therapy, the dose, the pharmacy, the funding, the follow-through. PharmPix manages all of them before they become spend.

Clinical review comes first, confirming the therapy is right for the member, including lower-net-cost equivalents like biosimilars.

For brand specialty drugs, Specialty Hub then routes each prescription to the pharmacy with the strongest contract, captures available financial assistance to offset plan cost, and assigns a dedicated case manager.

Where it fits the plan, Specialty Access programs add further levers, including specialty generics and international sourcing, each clinically guided rather than left as an unmanaged discount channel.

Plans typically see 30 to 40% average specialty savings.

Yes, and it's one of the most common reasons plans come to us. GLP-1s can be a sound investment or a runaway cost depending on how they're managed. We build clinical structure around eligibility, monitor adherence and appropriate use, and keep every prescription visible regardless of where it's filled, so the plans covering these drugs get the outcomes they're paying for.