Claims-level reimbursement visibility
Financial performance read from the individual claim, not from the summary that describes it.
Private sector
Claims-Level Visibility for Employers, Health Plans, and Payer Organizations
Stratos Insights helps self-insured employers, commercial health plans and Medicaid organizations see how their pharmacy benefit actually performs. By comparing what the plan is charged with what the pharmacy is reimbursed, claim by claim, Stratos quantifies spread pricing exposure, supports rebate validation and gives plan sponsors independent evidence on PBM performance and plan cost.
The gap between what the plan is charged and what the pharmacy is reimbursed.The Stratos discipline
Who We Support
Built for the Organizations Funding the Pharmacy Benefit.
Self-insured employers
Commercial health plans
State Medicaid organizations
Key Challenges We Address
Where Pharmacy Benefit Spend Gets Hard to See.
Plan cost is shaped by pricing, rebates and reimbursement behavior long before it reaches a summary report. These are the pressures Stratos is built to bring into view at the claim level.
- Rising pharmacy benefit costs
- Spread pricing exposure
- Rebate validation uncertainty
- Limited independent PBM performance visibility
- Claims-level financial opacity
- Plan cost management pressure
The Gap in the Middle
See What the Plan Is Charged Against What the Pharmacy Is Paid.
Spread pricing and rebate value live in the space between those two numbers. Stratos reads the claims themselves, so plan sponsors can see the gap instead of taking a summary’s word for it.
How Stratos Helps
Independent Reimbursement Analysis of Your Pharmacy Benefit.
PBM performance visibility
Whether PBM activity and reported outcomes actually align with what the plan expects.
Rebate validation support
Confirmation that the rebates a plan is owed are calculated, passed through and reconciled correctly.
Spread pricing analysis
What the plan is charged compared against what the pharmacy is reimbursed, quantified at the claim.
Payer performance analysis
How performance varies across payers and plans once the claims are grouped and measured.
Plan cost and financial accountability
Reporting clear enough for leadership and defensible enough to hold up under scrutiny.
Related
Where This Connects.
Frequently Asked Questions
Answers for Employers and Health Plans.
How does Stratos support employers and health plans?
Stratos helps private sector organizations, including self-insured employers, commercial health plans and Medicaid organizations, gain visibility into PBM performance, spread pricing, rebate validation, claims transparency and plan cost management through independent, claims-level analysis.
How can a self-insured employer tell if its PBM is using spread pricing?
A self-insured employer can detect spread pricing by comparing what the plan is charged against what the pharmacy is actually reimbursed at the claim level. Stratos Insights performs this independent, claims-level analysis to quantify spread pricing exposure and validate whether rebate and pricing terms are being honored.
What is rebate validation and why does it matter?
Rebate validation is the process of independently confirming that the manufacturer rebates a plan is owed are calculated, passed through and reconciled correctly. Stratos helps private sector organizations validate rebate performance against expectations using claims-level data, so plan sponsors can see whether they are receiving the value their contract promises.
Ready to See How Your Pharmacy Benefit Is Actually Performing?
Start with an independent, claims-level look at reimbursement performance, in clear, defensible terms your team can act on.