“PBMs are faced with the challenge of rethinking their operating models to eradicate legacy technology and ensure compliance with the constantly-changing medicare regulations, while also reducing costs,” says Martinez- Fraticelli, President & Chief Pharmacy Officer, PharmPix. At this juncture, the company brings in system and coordinated PBM services including claims processing to help clients meet the regulatory requirements to ensure compliance, drive cost reduction and revenue enhancement, improve efficiency and process transformation by capturing the untapped value of latest technologies. Transforming the way claims are processed, PharmPix has devised OneArk™ System Suite— an easier way that assists the PBMs to manage everything from supporting HIPAA compliance to managing care with a combination of clinical processes and technology. The simple and easy-to-use platform promotes fast and accurate plan and formulary design and brings pharmacy benefits management at the fingertips.
PharmPix’s dedicated platform for pharmacy ecosystem aims to meet the primary goals of Affordable Care Act (ACA), i.e., to expand access to health insurance, protect patients, and reduce costs. The traditional PBM technologies are ineffectual to keep track of expenditures by pharmacy ecosystem members or to integrate these expenditures with the medical benefit costs. The tracking, however, is essential to find a member’s phase, as the cost share of a member depends considerably on its running phase.
PharmPix has created a clinically smarter system that can process and pay claims as well as keep an eye on several variations such as the member of diagnosis and demographic information. This system can combat the increase in costs and utilization by avoiding waste and inaccuracies at the Point of Sale. The platform also comes embedded with real-time claims adjudication with point-of-sale eligibility validation, online safety and managed care editing and coordination of benefits capabilities. The system also helps in detecting the duplication of therapy for pharmacies through the Drug Utilization Review Program, thus preventing the potential issues at the POS. The company has also been harnessing AI to have smarter education pharmacy claims to adjudication.
PharmPix provides a thorough learning process wherein it trains clients about company’s clinical system at an early stage. The onboarding process can take around one week to two months for completion, depending upon the complexity of benefit designs. PharmPix’s platform helped one of its clients—having a health plan with 1000 different benefits and 100 different drug formularies—to save 15 percent in the pharmacy benefits with their groundbreaking solution. As their technological advancement continues to script success stories, PharmPix is forging ahead with a testing phase to harness AI in its platform to create huge benefits with fewer inputs.