A “virtual” full service PBM with an adaptable business model for different pharmacy delivery solutions. Establish a deeper connection with your beneficiaries and providers and save along the way.

PharmPix offers an innovative technology platform that effectively allows you to manage your pharmacy benefit costs: the OneArk™ Suite.

Our technology serves the ever-changing needs of health insurance industry professionals. It also helps you grow a deeper connection to your beneficiaries and providers.

PharmPix serves health plans, PBMs and other plan sponsors who manage Medicare, Medicaid, commercial, hospice and workers compensation business. The company is privately held, founded in 2009 as a corporation, and is currently doing business in all 50 U.S. states and territories. The company’s claims processing is hosted in a secure, highly specialized facility located in Las Vegas, Nevada.

The OneArk™ System Suite is the backbone of our services. It offers:

  • Real-time claims adjudication with point-of-sale eligibility validation, online safety, as well as managed care editing and coordination of benefits capabilities
  • Detailed claims reporting
  • User-friendly Member/Employee portal for retail pharmacy availability, formulary information and access to co-pay/plan design information
    Retail pharmacy contracting R30 & R90 fills, pharmacy call center and pharmacy audits
  • Medication Therapy Management (MTM) capability at point of sale with business rules processing engine (BRPS) for push notification via email and text messages
  • Mail service options
  • Specialty pharmacy options
  • Prior Authorization (both systemic & live clinical professionals)
  • Clinical program consulting, and Retrospective and Concurrent Drug Utilization Review (DUR)
  • Pharmacy and Therapeutics (P&T) Services
  • Manufacturer Rebate Management

An open-hub structure that truly lets you manage your pharmacy benefit.

PharmPix is a powerful tool available for you to manage your pharmacy benefit. We continuously provide you with the best pricing from every provider. Our open hub structure acts as a facilitator of key providers.

In other words, if a plan sponsor is already working with a preferred disease management company, specialty drug provider, etc., PharmPix will integrate and coordinate providers. We do not force clients to use only our service applications.

Full-service PBMs usually employ their own people and only provide in-house services. PharmPix is different. We provide all the necessary components for a full-service PBM contract, yet some of our services are contracted with a third-party provider. This gives our plan sponsors the flexibility to continue using their preferred provider for certain services.

Our flexible benefits model brings you the best service and pricing from all of our partners at once, delivering a competitive bidding process by default.

In other words, PharmPix facilitates the very best of every contract and every channel, and it continuously looks for the best from all providers. This is true management of your pharmacy benefit, and your company’s healthcare costs.

A technology platform that is powerful, simple and cost-effective: our OneArk TM system sets a new standard in clinical intelligence technology.

PharmPix’s innovative technology platform is user-friendly, fully customizable, and a class apart from the way most PBMs work. Take a closer look at our suite components:

  • The OneArk™ System Suite: The OneArk™ System Suite has been fully functional since 2009 and is managing around 1.5 M lives today. The OneArk™ Suite EDI, our PBM engine, along with its set of supporting applications, were created from the ground up following NCPDP’s Telecommunication Standards and CMS requirements. Our technology is based on a three-tier architecture that uses an object-oriented approach. This makes our system very flexible and customizable without having to custom-code to make changes to the workflow.
  • Security & Accessibility: Security and accessibility are key ingredients all throughout the design. At the base of our system is a relational database structure built to be highly transactional, while maintaining its referential integrity. This makes sure that your data is kept safe and its integrity maintained. This base structure is the key to managing high loads of transactions very fast and without much effort.
  • Control & Simplicity: The OneArk™ System Suite fosters control through the simplicity of its applications. By using OneArk™ CuBe, insurance companies, plan sponsors, and PBMs can take control, change the processing workflows and benefit designs without the need to code. All of this is done in minutes (not months!) by simply changing some properties in CuBe. This provides you with the ability to change your benefit components right when your company needs it the most, taking full advantage of the rapid change this industry experiences.
  • Full Compliance: The OneArk™ System Suite fully supports HIPAA compliance. Your members’ Personal Health Information (PHI) is always kept secure. With OneArk™ Security, you can create users and roles, plus assign which modules and apps they can access and what data these users can access and manipulate.
  • Emphasizes the Clinical through Technology: Our OneArk™ System Suite emphasizes a mix of clinical processes and technology by allowing professional overrides and supporting custom-managed care therapy algorithms with simplicity.
  • One Single Portal: All of OneArk™ System Suite’s apps are web-based. The OneArk™ Portal provides a secure, online single point of entry to access all of our apps. This makes it is easy to use, and promotes time spent on managing your care, not the technology.
  • Fast & Accurate Formulary Design: OneArk™’s unique selling advantage, the “POWER COPY” feature, promotes fast and accurate plan and formulary design in seconds. This saves you several key strokes, which are usually needed in legacy systems that require populating multiple screens, forms and fields.

Our tool lets you see what’s going on clearly.

Our Client Consultation Support includes a powerful, insightful reporting tool. We begin with our periodic Key Performance Indicators report. It provides clients a high-level view into specific drug utilization within the pharmacy benefit data and shows trends using the following categories:

  • PM Plan Cost
  • Drug Mix Indicators
  • Pricing Indicators
  • Utilization Indicators
  • Cost Share Indicators

Most utilized reports include:

  • Top 100 Pharmacies
  • Top 100 Medications
  • Top 100 Physicians

Based on these categories and reports, we find opportunities to save and manage care properly by helping you develop and implement strategies that identify opportunities for improvement.

All of these reports are created with an aggressive frame of Compliance and Quality Programs that include:

  • CMS Coverage Determination and Appeal Process
  • PDE Management
  • PDE-Claims Reconciliation Tool
  • Transition Plan
  • CMS 5-Stars Rating Program