The CLIP Framework
CLIP doesn’t replace your current PBM or TPA; it strengthens them. We integrate directly into existing adjudication workflows to identify, manage, and fulfill high-cost prescriptions through the optimal channel to significantly compress plan exposure.
How It Works
Data Intake &
Claims Analysis
We begin with a detailed analysis of
your paid claims data, identifying
opportunities for Statutory Pricing,
Global Sourcing, Manufacturer
Assistance, and GPO Contract Pricing.
Channel
Optimization
Our system evaluates each high-cost
prescription against multiple sourcing
pathways to find the most cost-effective
path based on clinical eligibility, plan
rules, and regulatory compliance.
Fulfillment & Case
Management
CLIP's fulfillment network spans licensed
domestic and international pharmacies
with robust cold-chain monitoring,
product serialization, and comprehensive
patient communication support.
Reconciliation &
Reporting
All data is reconciled for real-time
validation and claim-level transparency,
providing the plan sponsor with
audit-ready documentation for
every dollar saved.
Verified Savings &
Shared Value
Each channel's results are benchmarked
against traditional PBM pricing. Net
savings are verifiable, repeatable, and
delivered through a deterministic
net-pricing model.
The CLIP Advantage
-
Fiduciary Transparency
No hidden margins, opaque spreads, or undisclosed incentives. -
Seamless Integration
Works alongside existing PBM infrastructure, preserving BIN/PCN routing and accumulator integrity. -
Digital Concierge Engagement
An advanced notification engine providing automated SMS, email, and app-based alerts to simplify member enrollment and script fulfillment. -
Regulatory-Aligned Architecture
Built for ERISA and CAA 2026 compliance, utilizing settlor authority to protect plan assets. -
Deterministic Net Cost
Real-time visibility into realized savings rather than probabilistic rebate estimates.
