Your PBM's most complex questions,answered in seconds.
Claimalytics uses agentic AI orchestration to search your formularies, analyze drug pricing, check prior authorization criteria, and synthesize answers — all from a single conversation.
You
Claimalytics
Based on your commercial formulary, Humira requires prior authorization with step therapy through adalimumab biosimilar.PA-2024-031 p.12Quantity limited to 2 pens per 28 days.QL-Formulary p.47
The PBM Intelligence Gap
Pharmacy benefit management runs on documents, data, and institutional knowledge — none of it easily searchable, none of it connected.
Buried in Documents
Formularies, clinical policies, PA criteria — hundreds of pages across dozens of PDFs. Finding one answer means searching through multiple documents manually.
Slow Turnaround
A clinical pharmacist spends 15–25 minutes per question researching what should take seconds. Drug information requests pile up. Formulary questions go back and forth over email.
Siloed Knowledge
Pricing data in one system, formulary status in another, PA criteria in a PDF, and tribal knowledge in someone's head. No single place to ask a question.
AI That Doesn't Work
Generic AI chatbots hallucinate drug information. They can't cite sources. They don't understand PBM-specific terminology or workflows.
Not just a chatbot.
An AI team that works together.
Claimalytics employs a multi-agent orchestration system where specialized AI agents collaborate to answer your questions with precision.
Triage Agent
Analyzes every question to understand intent, then routes to the right specialist. Handles general questions directly. Orchestrates across agents for complex queries.
Document Intelligence
Searches uploaded formularies, clinical policies, and PA criteria using hybrid semantic + full-text search. Every answer includes inline citations with exact page numbers.
Drug Pricing
Retrieves real-time drug pricing, copay information, and reimbursement rates. Compares brand vs. generic costs. Surfaces pricing trends and anomalies.
Prior Authorization
Checks PA requirements, step therapy protocols, and quantity limits for any drug. Tells you exactly what's needed before a prescription can be approved.
Formulary Lookup
Instant tier status, coverage determinations, preferred/non-preferred classifications, and restriction details. No more Ctrl+F through a 400-page PDF.
Compliance & Regulatory
Cross-references policies against CMS Part D requirements, state mandates, and accreditation standards. Proactive identification of compliance gaps.
Triage Agent
Analyzes every question to understand intent, then routes to the right specialist. Handles general questions directly. Orchestrates across agents for complex queries.
Document Intelligence
Searches uploaded formularies, clinical policies, and PA criteria using hybrid semantic + full-text search. Every answer includes inline citations with exact page numbers.
Drug Pricing
Retrieves real-time drug pricing, copay information, and reimbursement rates. Compares brand vs. generic costs. Surfaces pricing trends and anomalies.
Prior Authorization
Checks PA requirements, step therapy protocols, and quantity limits for any drug. Tells you exactly what's needed before a prescription can be approved.
Formulary Lookup
Instant tier status, coverage determinations, preferred/non-preferred classifications, and restriction details. No more Ctrl+F through a 400-page PDF.
Compliance & Regulatory
Cross-references policies against CMS Part D requirements, state mandates, and accreditation standards. Proactive identification of compliance gaps.
Measurable impact,
from day one.
Built for the people who
run pharmacy benefits.
VP Clinical / Chief Pharmacist
- 15–25 min → 10–30 sec per clinical query
- Cited answers traceable to source documents
- PA, formulary, and drug info — one conversation
CIO / CTO
- Deploys in your Azure tenant — PHI never leaves
- Zero-trust security with managed identities
- No vendor lock-in: BYOC architecture
CFO / VP Finance
- 75% cheaper than traditional SaaS infrastructure
- Transparent pricing: our fee + your Azure costs
- ROI from the first question on the first day
Real impact,
real workflows.
A formulary manager's morning, transformed
“What used to take two hours of searching through PDFs and cross-referencing spreadsheets now takes 30 seconds. I ask Claimalytics a question, get a cited answer, and move on to the next decision.”
Formulary Manager
Drug coverage research
Onboarding a new health plan client
“We uploaded their entire formulary, clinical criteria, and PA policies. Within the hour, our whole team could search and query the complete document set — no training required.”
Clinical Operations Director
Client onboarding
Ready to see Claimalytics
in action?
We'll walk you through a live demo with your own documents.