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Better Business

PharmPix Corp, founded in April 2009, is a pharmacy benefit information and management company. We believe that the consolidation of large PBMs has disrupted service levels and customer loyalty as priorities shift to Wall Street, now more than ever. This business trend accelerates the appetite for aggregators of beneficiaries to take control of their pharmacy benefit strategies and the methods of delivering these programs under their own brand. PharmPix is in business to provide new innovative strategies, greater access to more useable information and coordinated services for health insurers, government health programs including Medicaid and Medicare, and Prescription Benefit Managers (PBMs). PharmPix will not compete with its customers under any circumstance.

PharmPix operates as a technology focused PBM, serving cost-conscious pharmacy benefit payers and/or administrators that are looking for a trustworthy business partner. We deliver savings through clinical and administrative efficiencies supported by our state-of-the-art proprietary technology.

PharmPix has become a leading provider of pharmacy benefit solutions and services in Puerto Rico and in the continental United States. The OneArk™™ technology can be purchased as an Application Service Provider (ASP), on a per-claim basis. PharmPix will also provide health plan sponsors and PBMs a wide range of reporting and analytical tools to support analysis and subsequent management of quality and cost of this increasingly important component of their health benefits offering.

We do business with and for people

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Win-Win Solutions

We know who our clients are and our decisions reflect their best interests. In general, PBMs help clients reduce costs. However, in many relationships, PBMs have a model that requires utilizing contracts that are financially beneficial to the PBM first. PharmPix believes that acting on behalf of our clients is our responsibility, even if this means we will not profit from all decisions.

PharmPix also believes that managing the pharmacy benefit most efficiently may require using a partner company’s solution other than our own. If the plan sponsor agrees, and we can find a reasonable way to integrate both companies, we will do this.

Ultimately, our goal is to find the most efficient and economical care path for beneficiaries. This is how we come up with a win-win scenario for everyone involved.

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Transparency

PharmPix believes that a true partnership means complete trust. Full disclosure and mutual accounting make it possible for trust to flourish. Objectives and incentives can then become aligned. The only way that a PBM can accomplish this is by disclosing all elements of our third party contracts and creating fee structures that motivate the proper decisions.

The term “transparency” is overused in our industry, and frankly, it’s not always achievable. In most situations, rates are derived by averages and not by individually adjudicated claims. Subsidy rates completely conflict transparency and misalign goals. Products that are bought, placed into inventory and later sold (i.e., mail and specialty) are rarely dispensed for actual acquisition costs. This is due to special pricing considerations via volume, repackaging and/or dynamic inventory pricing that is not contemplated in PBM/Plan sponsor contracts.

Transparency is derived by full disclosure and mutual accounting of the actual payments that are being made, along with the adjudicated claims on record, with a coordinated and fair fee structure that pays according to the services rendered and actual results achieved.

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Added Value

PharmPix doesn’t just look for discounts and rebates, but also for ways to change behavior and manage utilization in order to foster a real PBM relationship.

Often, PBMs will attempt savings-sharing models and base their saving assumptions on changes in the reimbursement, such as cost shifting, coordination of benefits, or the increase of generic alternatives entering the market place. A “Value Add” in pharmacy management is realized beyond the standard core components of an outsourced pharmacy department.

PharmPix believes that discounts and rebates matter, but changing behavior, managing utilization, controlling Fraud Waste and Abuse (FWA) and reducing inefficiencies in the claim adjudication are the real values of a true PBM relationship. The following table shows you the difference:

Feature
Standard
Added Value
Plan sponsor's claims reporting package
Payment validation according to the current plan design
Clinically-safe recommendation to decrease unnecessary utilization or replace
current utilization with a more economic therapeutic exchange
Owns and executes and implementation plan to make sure our recommendation
is a success
Aggressive FWA programs
System efficiencies that prevent incorrect adjudication of claims

Our Networks

PharmPix has retail pharmacy distribution contracts with all of the major pharmacy chains and numerous independents. The broad network of around 60,000 pharmacies provide necessary access for beneficiaries.

The OneArk™ system provides the ability to build several retail network options. Using the functionality known as PACMAN, users can build restricted networks within specific accounts. Managing retail networks at this level can provide a meaningful impact to maximizing pharmacy benefit expenses, as well as offer plan sponsors multiple prescription fulfillment options and plan designs.

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