A full-service PBM
PharmPix has developed an innovative technology platform that effectively allows you to manage your pharmacy benefit costs. It is called the OneArk™ System Suite. This technology serves the ever-changing needs of health insurance industry professionals. Meanwhile, it helps you grow a deeper connection to your beneficiaries and providers.
PharmPix provides services to health plans who manage Medicare, Medicaid and commercial business. Our system and coordinated PBM services are also built for large employers/unions and worker’s compensation lines of business.
The company is privately held, was organized in 2009 as a corporation, and is based in Guaynabo, Puerto Rico. The firm’s claims processing is hosted in a highly specialized facility located in Nevada.
Our OneArk™ System Suite™ supports our services, which offer:
- Real-time claims adjudication with point-of-sale eligibility validation, online safety and managed care editing and coordination of benefits capabilities
- Detailed claims reconciliation reporting
- 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 a 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)
- Member services call center
- Clinical program consulting, and Retrospective and Concurrent Drug Utilization Review (DUR)
- Pharmacy and Therapeutics (P&T) Services
- Manufacturer Rebate Management
An open-hub structure
PharmPix really manages your pharmacy benefit by continuously providing you with the best pricing and benefits 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, or 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 use their own people and only provide in-house services. PharmPix is different. It provides all the components that are necessary for a full-service PBM contract, yet some of our services are contracted with a third party provider. This allows for plan sponsors to continue using their preferred provider for certain services.
This model can bring the best service and pricing from all partners. Therefore, it delivers a competitive bidding process within. Simply put, PharmPix facilitates the very best of every contract and channel, and continuously looks for the best from all providers. In a sense, this is truly managing your pharmacy benefit.BACK TO TOP
A new technology platform
PharmPix’s innovative technology platform is easy to use, fully customizable and is set to change the way PBMs work. Take a closer look at our components:
The OneArk™ System Suite
The OneArk™ System Suite has been functional since 2009. OneArk™ EDI, our PBM engine, and all of its supporting applications, have been created from the ground up following NCPDP’s Telecommunication Standards and CMS requirements. The technology is 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 and Accessibility
Security and accessibility have been key ingredients all throughout the design. At the base of this system is a relational database structure built to be highly transactional while maintaining its referential integrity. This ensures 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 and Simplicity
The OneArk™ System Suite fosters control through the simplicity of its applications. By using OneArk™ CuBe, insurance companies, plan sponsors, and even PBMs can take control, change the processing workflows and benefit designs without the need to code. All of this is done in just minutes (not months!) just by changing some properties in CuBe. This provides you with the ability to change benefit components right when your company needs it and takes full advantage of the rapid change this industry experiences.
The OneArk™ System Suite fully supports HIPAA compliance. Your members’ Personal Health Information (PHI) is always secure. With OneArk™ Security, you can create users and roles and assign which modules and apps they can access and what data these users have the needs to see.
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.
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 sure that it is easy to use, and promotes time spent on managing your care, not the technology.
Fast and Accurate Formulary Design
OneArk™’s unique selling advantage, the “POWER COPY” feature, promotes fast and accurate plan and formulary design in a matter of seconds. This saves users several key strokes, which are usually needed in older applications that require populating multiple screens, forms and boxes.BACK TO TOP
A strategic reporting tool
With our meaningful reporting tool comes with our Client Consultation Support. We start with our periodic Key Performance Indicators report. It gives clients a high-level lens into specific drug utilization within the pharmacy benefit data and shows trends using the following categories:
- PMPM Plan Cost
- Drug Mix Indicators
- Pricing Indicators
- Utilization Indicators
- Cost Share Indicators
Other popular reports include:
- Top 100 Pharmacies
- Top 100 Medications
- Top 100 Physicians
Based on these reports, we find opportunities to save and manage care properly by helping you develop strategies to identify opportunities for improvement. All of these reports are created within 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