You Don't Need New Programs. You Need Enforcement.
Clinical Insights & Program Management
We believe clinical best practices begins with simply making sure the PBM is doing the job you hired them for
Our Clinical Bench is Built Like a Strike Team
PharmDs, outcomes researchers, specialty pharmacists, health economists, benefit coders, and ex‑PBM clinical policy owners serve as the backbone for our clinical performance ethos.
We start by standing up our clinical Spectra operating model that assigns a dedicated Prism clinician to baseline your formulary, benefit design, and claims edits, then hard‑wire best practices into plan policy, utilization criteria, and day‑to‑day governance.
From there, we move fast where the money and clinical best-practice moves: biosimilar exclusivity for drugs like Humira and Stelara with proactive member transitions and intelligent benefit design. We hold PBM’s accountable to clinical best practices, contractual benefit design expectations, and ensure a balance between the highest quality of care at the lowest net cost.
TRANSLATION
Our clinical performance ethos ensures patients receive the right drugs for the right price.
The Prescription for Clinical Performance Excellence
It starts with data. Because you cant improve what you cant measure.
Our team of data analysts work to transform client claims data into meaningful trend and performance metrics that empower our dedicated team of clinicians to identify a range of opportunities. This ensures clinical compliance with intended benefit design and introduce opportunities for cost savings and enhancement of quality outcomes.
This is your pharmacist in a box®. An extension of your benefits team. Proactively identifying risk, intervening where it matters, and responding in real time to clinical questions with clarity and confidence.
Spectra provides a dedicated clinical pharmacist who is deeply integrated into plan design and decision-making. Every recommendation is evidence-based, data-driven, and focused on lowest net cost outcomes that preserve or improve clinical quality.
End‑to‑end review of formulary, clinical programs, claim‑level edits, preventive lists, and coverage policies; we publish specific recommendations your PBM can actually operationalize.
Strong stances where they matter: DAW penalties, compound controls, OTC/sexual‑dysfunction exclusions unless you opt in, and sensitive categories (gender identity, infertility, abortifacients) mirrored cleanly to your SPD with lowest‑net‑cost logic.
A named Prism clinician stays on the file — fielding benefit decisions, evolving policy, and holding the PBM to clinical best practice week‑over‑week.
WHAT IS SPECTRA?
Spectra is a comprehensive clinical oversight and pharmacy analytics program designed to ensure pharmacy benefits are clinically sound, cost-effective, and defensible.
It combines rigorous plan design governance, continuous claims surveillance, and high-touch pharmacist support to identify waste, prevent misaligned utilization, and drive measurable savings—without compromising member care.
AT ITS CORE
Spectra delivers 3 integrated capabilities:
Strategic Clinical Intelligence
Precision Utilization Monitoring & Intervention (PUMA + Sentinel)
Clinical Plan Design Blueprint & Concierge Support
Strategic Clinical Intelligence
Through semi-annual or annual Strategic Reports, Spectra performs forensic analysis of top drug spend categories, pinpointing the exact medications driving trends and providing targeted, evidence-based recommendations. These insights are supported by deep utilization reviews, GLP-1 monitoring, fiduciary benchmarking, and generic and biosimilar optimization
Precision Utilization Monitoring & Intervention (PUMA + Sentinel)
Spectra continuously monitors claims activity using an evolving rules engine that flags high-risk or high-cost scenarios—such as duplicate therapy, inappropriate utilization, and emerging specialty trends. Monthly reporting highlights these interventions and actions taken, enabling proactive course correction rather than reactive cost containment, pinpointing the exact medications driving trends and providing targeted, evidence-based recommendations.
Clinical Plan Design Blueprint & Concierge Support
Every Spectra engagement begins with a detailed Clinical Plan Design Blueprint that establishes a “clinical source of truth” for how the pharmacy benefit should operate. This blueprint becomes both a working reference and audit tool, ensuring claims adjudicate correctly while identifying levers to improve outcomes and spend over time. Dedicated Prism clinicians act as an extension of the client’s team—supporting plan design decisions, member-specific scenarios, and ongoing strategy
The result:
A pharmacy benefit that is continuously validated, clinically aligned with best practices, and actively managed—rather than passively observed.
This isn’t advisory theater
Designed to Prevent:
Policing GLP-1's with Discipline
How? Detect GLP‑1/DPP‑4 overlaps and kill them; clamp the first 90 days to 28‑day fills; and secure manufacturer assistance when the PBM can actually apply it. It’s evidence‑anchored, cost‑aware, and implementation‑ready.
And because dashboards don’t lower costs — we pair this with RxKai reporting so your team gets an action brief, not a vanity graph. You’ll see what to change, by when, and the yield we expect — then we push those decisions into contract language and UM criteria so they stick.
Word for the wise…
If a glossy portal could fix pharmacy, it would have been done by now.
Ready to save on healthcare?
Let’s optimize your pharmacy benefits and drive down costs. Our team of experts is here to guide you through every step of the process. From regulatory compliance to patient savings, we’ve got you covered. Don’t leave money on the table—reach out today and discover the difference.