Solutions
Purpose-built for the people who
run pharmacy benefits.
Every role in PBM has different questions, different workflows, and different priorities. Claimalytics speaks your language.
Clinical Teams
VP Clinical, Chief Pharmacist, Clinical Pharmacists
The Challenge
- 15–25 minutes per clinical query searching through 400+ page formulary PDFs
- PA criteria buried across dozens of documents with no cross-referencing
- Drug information requests pile up — staff can't keep pace
- No trusted AI option: generic chatbots hallucinate drug data
How Claimalytics Helps
- Instant PA requirements, step therapy chains, and quantity limits from your own documents
- Formulary tier status with preferred alternatives and generic equivalents
- Drug information from FDA-approved sources (openFDA, RxNorm, DailyMed)
- Every answer cited to exact document and page — verify in one click
10–30 sec
per clinical query (from 15–25 min)
25–42 hrs
saved daily across a 10-person team
2–4 FTEs
equivalent capacity gained
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 a question, get a cited answer, and move on.”
— Formulary Manager
Finance & Analytics
CFO, VP Finance, Claims Analysts
The Challenge
- Drug pricing data scattered across NADAC, AWP, WAC, and internal systems
- Claims analytics requires SQL expertise or weeks of report requests
- No visibility into AI cost — black-box SaaS billing
- ROI hard to prove without granular usage tracking
How Claimalytics Helps
- Real-time NADAC pricing, brand vs. generic cost comparisons, patient cost estimation
- Natural language claims analytics: "Show me top 10 drugs by spend last quarter"
- Transparent pricing: our platform fee + your Azure infrastructure costs, visible to the penny
- Per-query cost tracking and immutable audit trail for every AI interaction
$0.01–$0.05
per query (from $8.75–$22.92 manual)
$1,167–$18,333
monthly value per user
Day 1
break-even on Starter tier
Pricing transparency that builds trust
“For the first time, I can see exactly what our AI costs — down to the token. Our Azure bill is ours, their platform fee is theirs. No surprises.”
— VP Finance, Mid-Market PBM
Compliance
Compliance Officers, Regulatory Affairs, Legal
The Challenge
- 10–15 new federal reporting requirements announced in 2026 alone
- CMS Part D rules change frequently — manual tracking is unsustainable
- PHI in third-party SaaS creates procurement and BAA complexity
- Audit readiness requires documenting every clinical decision rationale
How Claimalytics Helps
- Regulatory monitoring agent tracks Federal Register for proposed and final rules
- Cross-reference policies against CMS Part D requirements automatically
- BYOC architecture: PHI never leaves your Azure tenant — simplified BAA
- Immutable conversation logs with full audit trail for every query and response
Zero PHI
exposure to third-party cloud
100%
query auditability
Simplified
BAA — you control the data
Compliance without the compliance theater
“The BYOC model eliminated our biggest procurement blocker. PHI stays in our tenant, we control encryption and access, and every AI interaction is logged.”
— Chief Compliance Officer
Consultants & Advisors
PBM Consultants, Benefits Advisors, TPAs
The Challenge
- Each client has different formularies, PA criteria, and plan designs
- Research for client deliverables takes hours per engagement
- Need to support multiple clients without dedicated staff per client
- No affordable AI tool designed for PBM consulting workflows
How Claimalytics Helps
- Upload each client's documents separately — instant knowledge base per engagement
- Research in seconds: drug pricing, PA requirements, formulary comparisons
- SaaS individual plan at $49/month — affordable for solo practitioners
- White-glove accuracy: every recommendation backed by cited sources
$49/mo
SaaS plan for individual consultants
10x
faster client research
First query
pays for itself
Scaling expertise without scaling headcount
“I uploaded a new client's entire formulary and had answers to their top 20 questions within an hour. That used to be a full week of billable work.”
— Independent PBM Consultant
Find your use case
Let us show you how Claimalytics works for your specific role and workflows.