Specialty Drug Spend, PDMP & Interaction History per Claimant
The pharmacy line is where 40% of stop-loss exposure quietly hides. RiskFlow shines a light on it.
Pharmacy Monitor surfaces specialty drug spend by employer and diagnosis category, tracks per-claimant opioid and specialty medication history, integrates with PDMP queries for controlled substances, and reviews drug interaction history — all from the same dashboard where the broker lives.
Aggregate and per-claimant specialty drug spend, broken out by employer group and diagnosis category, with month-over-month trend.
Per-claimant PDMP queries surface multiple prescribers, multiple pharmacies, early refills, and out-of-state dispensing patterns.
Per-claimant drug interaction history shows recent checks, severity, and resulting recommendations — surfaced inline on the claimant record.
Counts of specialty drugs per claimant and per employer feed the high-cost member view and renewal narrative.
Pharmacy claims are loaded alongside medical claims and matched to the same de-identified member IDs.
Specialty drugs are categorized and per-claimant and per-employer specialty counts and spend are computed.
Controlled-substance query results attach to the claimant record; multiple-prescriber and early-refill flags surface.
Pharmacy insights surface inline on the employer dashboard, claimant card, and renewal narrative AI prompt.
“We caught a claimant on four different specialty biologics across three pharmacies. The intervention saved our client $94K that year.”