PBM Pass-Through Intelligence
Stop the spread. Pay the real price.
An AI agent that reads your pharmacy claim file every morning, compares every single fill against five public benchmark sources, and flags the exact dollar amount your plan is being overcharged.
The Problem
Every self-funded employer in America is overpaying for prescription drugs
The culprit is spread pricing — the quiet practice where a Pharmacy Benefit Manager charges your plan one price for a drug, reimburses the pharmacy a lower price, and pockets the difference. On a single generic fill, the spread might be two dollars. Across a 5,000-life plan filling 60,000 scripts a year, that same practice quietly drains seven figures out of the health plan and into the PBM's margin.
The contracts that govern this are intentionally opaque. Rebates are redefined every renewal cycle. "Pass-through" often means pass-through of some revenue streams, not all of them. MAC lists update weekly without notification.
Features
What the agent does
Continuous claim surveillance
The agent doesn't wait for quarterly reports. Every claim is priced against NADAC, WAC, AWP, GoodRx cash pricing, and a panel of transparent pass-through PBM benchmarks.
Spread detection
Where the spread exceeds your contracted rate, the agent generates an audit-ready dispute packet with line-level evidence, calculated recovery, and suggested language.
Rebate tracking
Cross-references manufacturer rebate schedules against what your PBM actually passed through. Identifies the delta to the penny.
Plain-English reports
Every morning you get a summary: drugs flagged, estimated annual savings, and next steps. No spreadsheet decoding required.
Ready to see what you're really paying?
Upload a single month of claims. We'll show you the spread.
Schedule a Demo