For Independent and community pharmacies, single store or a small group
Find claims that paid less than the drug cost you
A claim adjudicates, the bag goes out, and nobody checks that the payment covered the cost of the drug. Underwater claims repeat on the same drugs and the same plans every month, and the total only shows up in a spreadsheet reconciliation, if anyone does one.
What it can cost you
Example: 120 underwater claims a month x $9 average loss = $1,080 a month, or $12,960 a year.An illustration, not a promise. Your Opportunity Scan puts a real number on it.
What the system checks overnight
- Matches each paid claim to your latest acquisition cost from wholesaler invoices.
- Flags claims where reimbursement fell below cost.
- Groups underwater claims by PBM, plan, and NDC.
- Lists the drugs that go underwater most often and the dollars lost on each.
- Lists claims that may be eligible for a pricing appeal, with the appeal deadline your contract allows.
Where it reads from
- PioneerRx
- BestRx
- Liberty Software
- QS/1
- Computer-Rx
- McKesson Connect
- Cardinal Health Order Express
Wholesaler invoice costs as they arrive, read as data only.
What happens when it fires
The owner decides which claims to appeal and which drugs to review. The system drafts the appeal list with the claim and cost details.
Autonomy level: Draft for approval. The system prepares the message or task, and you approve it before anything goes out.
What we guarantee
Every claim from the prior day is checked against acquisition cost by the next morning. We agree on the metric before the Sprint starts and measure it over the first 20 business days after go-live. If we miss it, you get half your Sprint fee back. Dollar savings are tracked in your monthly saves log, reported rather than promised.
Questions
Does the system use patient information?
No. It works from claim amounts, NDCs, plans, and costs. Patient names and details stay out of the AI.
Does it decide whether to fill a script?
No. It reports the margin. Whether and how to fill a prescription is always the pharmacist's decision.
Will it file appeals for me?
It drafts the list and details. Your staff files appeals through the PBM or your services organization.
Do I need new software for this?
No. The system reads from the tools you already use, with read-only access by default. A guardrail layer controls exactly which data the AI can see.
What does it cost?
A 3-week Sprint is $6,000 fixed and includes the morning brief plus one automation tied to an agreed metric. Ongoing support is $1,500 a month, or $500 a month to keep it running without new automations. If the agreed metric is missed over the first 20 business days after go-live, half the Sprint fee is refunded.
How is this different from a dashboard app or a free AI kit?
A dashboard app shows numbers when you go look. A free AI kit gives you the parts, and you do the setup, the upkeep, and the checking. Here the alarms are built for your kind of business, they watch outside data like market rates and rule changes alongside yours, and on Run or Keep-Running, the person who built them keeps them working and logs what they caught.
More alarms for independent pharmacies
Seven more things worth watching.
- Fee clawback driftCompare the fees PBMs take back after payment to what you expected, by PBM and month, and see your true margin per script after clawbacks.
- Will-call bags not reversedCount pharmacy will-call prescriptions not picked up, claims not reversed before the payer's window, and stock that should go back on the shelf.
- Dead and expiring stockFlag pharmacy stock with no dispensing in months, items nearing expiry, and products still inside wholesaler return windows, by value.
- Stockouts and owed fillsTrack pharmacy out-of-stocks, partial fills, owed quantities, and transfers out caused by missing stock, by NDC and week.
- Wholesaler cost increasesFlag pharmacy items where wholesaler cost jumped, generics bought off your primary contract, and OTC items priced below your target margin.
- PBM payments late or shortCompare expected PBM payments to deposits by payer and cycle, and flag late or short payments before they squeeze your cash for the next order.
- Staffing vs script volumeCompare pharmacy technician and pharmacist hours to scripts filled by hour and day, and flag short shifts and overtime building up before payroll.
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