CLAIMS INFRASTRUCTURE FOR THE POST-PBM ERA

Make Transparent Pharmacy Plan-Eligible

Cost Plus charges $4.50 for Metformin. Traditional PBMs charge $85. But only the PBM purchase counts toward your deductible. We fix that.

The False Choice Patients Face

Transparent pharmacies offer 70-90% savings. But those purchases don't count toward employer health plan deductibles or out-of-pocket maximums.

So patients rationally choose the expensive PBM option to accumulate deductible credit. Transparent pharmacies lose. Patients lose. Only PBMs win.

Cost Plus Drugs $4.50
Metformin (30-day)
Transparent markup, no hidden fees
Doesn't count toward $3,000 deductible
— VS —
Traditional PBM $85
Metformin (30-day)
Hidden spread pricing, rebate games
Counts toward deductible
⚖️

ERISA Attorneys

Documented governance workflows for fiduciary defense. Audit trails that demonstrate prudent action.

👤

Patients

Finally: cheap drugs AND deductible credit. No more false choice.

See What Your PBM Is Really Charging

Upload your claims data or use sample data to reveal the hidden markup

Company Information

Accrue Bridges the Gap

We convert transparent pharmacy transactions into EDI claims that employers recognize

💊
Patient Buys
Cost Plus, Amazon Pharmacy, GoodRx
📡
Webhook
Transaction sent to Accrue
📋
EDI 837P
Claim generated (ANSI X12)
🏥
Clearinghouse
Submitted via Availity
Deductible Credit
Applied to member

Complete Claims Infrastructure

Everything needed to make transparent pharmacy purchases plan-eligible

🔐

Member Auth

JWT authentication, member linking, role-based access. HIPAA-compliant.

📡

Pharmacy Webhooks

Receive transactions from Cost Plus, Amazon, GoodRx. Self-service setup.

🔄

Transaction Processing

Normalize, validate, match to members. Confidence scoring.

📋

EDI 837P Generation

Full ANSI X12 professional claims. Version 005010X222A1.

🏥

Clearinghouse

Availity integration. 999/277/835 handling. Retry logic.

📊

Accumulator Tracking

Real-time deductible/OOP. Three-way reconciliation.

💳

Billing Service

PEPM, transaction, or hybrid pricing. Stripe integration.

📱

Member App

Mobile-optimized. Transaction history. Savings dashboard.

The Fiduciary Funnel

Consumer awareness drives enterprise adoption at zero marginal cost

The Fiduciary Defense Kit

HR directors don't act because they're afraid — of relationships, retaliation, competence, legal exposure, and career risk. The Fiduciary Defense Kit solves each fear with a governance-compliant workflow.

Once an HR director has documented evidence of PBM pricing variances, ERISA § 404 creates personal fiduciary liability. The only safe path is a formal governance review — and all roads lead to transparent pharmacy.

1
Aletheia Extension
Patient sees PBM pricing variance
2
ERISA § 503 Dispute
Documented evidence sent to HR
3
Fiduciary Lens Dashboard
Governance risk indicator + audit workflow
4
PBM Exit
Employer switches to transparent pharmacy + Accrue

Complete the Picture with Yinsen

Prior authorization decision support that catches the twin sins of healthcare

Project Yinsen

A cognitive reasoning engine that evaluates clinical cases against evidence-based guidelines. Not pattern matching — actual clinical judgment.

  • Clinical Feature Extraction — Symptoms, imaging, prior treatment history
  • Evidence-Based Criteria — Not just CPT code matching
  • Twin Sins Detection — Flags both inappropriate denials AND approvals
  • Transparent Reasoning — Full decision explanation, zero black boxes
Try Yinsen Live →
🚫

Sin of Omission

Necessary care denied. FDA-approved devices blocked by outdated rules.

⚠️

Sin of Commission

Unnecessary care approved. Revenue-driven procedures with no benefit.

100%
Decisions Explainable

The Numbers

70-90%
Pharmacy Savings
50-80%
Typical Rx Savings
$3.50
PEPM Starting Price
0
Hidden Fees

Built For

🏢

Self-Funded Employers

Stop paying 5,000% markups on generics. Let employees use Cost Plus AND get deductible credit.

👔

Benefits Consultants

Differentiate with transparent pharmacy integration. The Fiduciary Kit generates leads automatically.

🏥

TPAs

Add transparent pharmacy support to your platform. We handle the EDI complexity.

💊

Transparent Pharmacies

Enterprise customer acquisition. All roads lead to your pharmacy when the governance process completes.

Ready to Exit the PBM?

Deploy claims infrastructure that makes transparent pharmacy purchases plan-eligible. Your employees deserve both savings AND benefits.

IRIS // ASSISTANT
STATUS: ONLINE
Greetings. I am Iris, the Solstice assistant. Ask me about Solstice Accrue, healthcare claims processing, PBM exposure analysis, or any of our intelligent infrastructure.
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