Three pressures landed at once: CAA fiduciary duties, the CMS-0057-F FHIR API deadlines (January 2027), and GLP-1s going from cost line #32 to #1. The data that regulators, plan clients, and finance all demand is locked in datasets that were never harmonized.
Claims, rebate contracts, eligibility, formularies, prior-auth. The GLP-1 story scattered across systems that don't agree.
NDC ≠ contract line? QBR: week 3 of 3
Claims, contracts, and eligibility restructured to one FHIR-native model. The same shape CMS-0057-F demands anyway.
FHIR-native · X12 · NCPDP
Hundreds of non-standard client formularies normalized to one comparable model; every number bound to its contract clause and claim.
field-level lineage
A single governed model binding claims, contracts, rebates, eligibility, and formularies. Running in your own cloud.
one class, one truth
Net-cost answers by drug class, auto-generated QBRs, and fiduciary evidence where every figure traces to source.
audit-ready, client-ready
Plan sponsors must prove prudent management. Every number in your reporting traces to source contract clauses and claims. Or it's an exposure.
Patient Access, Provider Access, Payer-to-Payer, and Prior Authorization APIs. All FHIR. A FHIR-native harmonized layer feeds them from one model instead of four projects.
Deployed in your environment. Claims and member data never leave your walls. Which is the answer your compliance office wants to hear first.
Plan clients generate the Quarterly Business Review automatically instead of waiting for it to be assembled by hand. With real-time access to their own analytics.
Score formulary changes to show where one drug's increased spend nets a decreased cost across the class. With full audit trails.
Hundreds of non-standard client formularies normalized to one comparable model, so tiering compares side by side and customizes per client.
Bid grids, disputes, formulary status, and reporting in one place. On the same governed data as the QBR.
Analysis with timing for action. When to move, not just what moved.
Every number traces to contract clauses and claims. Fiduciary-grade by construction.
Utilization, adherence, prior-auth, step therapy, and discontinuation in one unified view.
Coverage decisions grounded in what the harmonized data shows. Defensible to sponsors and members alike.
The same layer underneath this offering was validated in a published federated study across 47 U.S. healthcare institutions. Without moving a single raw record.
Talk to us about getting your pharmacy data AI-ready. We will walk your team through the FHIR-native architecture on your claims, contracts, and eligibility data.