How PharmaFix handles accuracy
The short answer
PharmaFix estimates your aberrancy position from the claim-level fields in your own report, on both the dollar and claim-count tests. It helps you monitor and understand the report; it does not provide legal or clinical advice and does not guarantee any outcome.
What the analyzer reads
The analysis uses supported claim fields: date filled, BIN (and group when present), NDC, and amount paid. Direct patient identifiers are prohibited. NDCs are normalized into candidate billing formats and compared with the versioned reference set bundled with the analyzer.
The two tests
- Dollar test: aberrant paid dollars as a share of total paid dollars.
- Claim-count test: aberrant claims as a share of total claims.
The two can diverge, because one high-dollar aberrant claim moves the dollar test while barely touching the count. PharmaFix tracks both so you see your full position.
Effective rate and room remaining
The displayed rate is the cumulative matched share for the selected report month. Room remaining is a mathematical estimate of the distance to a 25% reference line under the analyzer's assumptions, shown in dollars and claims; it is not a dispensing recommendation.
The two tests side by side
| Dollar test | Claim-count test | |
|---|---|---|
| Measures | Aberrant paid dollars ÷ total paid dollars | Aberrant claims ÷ total claims |
| Moved most by | A few high-cost aberrant claims | Frequent aberrant dispensing |
| Example | $18,000 ÷ $100,000 = 18% | 30 ÷ 1,000 claims = 3% |
| Blind spot if watched alone | Misses frequency creep | Misses a single expensive claim |
In that example the same pharmacy reads 18% on dollars but only 3% on count. Neither number is wrong; they answer different questions, which is why the report always shows both.
What the tool can and cannot do
- It helps you estimate and monitor your position and understand your report.
- It supports internal review on your own schedule, before reconciliation.
- It cannot guarantee any outcome with a PBM, and it does not speak for any PBM.
- Results are only as current as the bundled aberrant-NDC list at the time of analysis.
Honest by design
Every result carries plain-language notes about how the number was computed and what is not yet confirmed, so a figure is never read as more certain than it is.
Frequently asked questions
Is the number guaranteed to match my PBM's?
No. PharmaFix estimates your position from your own report to help you monitor and review internally. It does not speak for any PBM and does not guarantee an outcome.
Which test should I trust?
Both. They answer different questions and can disagree. PharmaFix shows the dollar test and the claim-count test together.
How are NDCs matched?
In canonical 11-digit form. A 10-digit NDC is padded by its segment layout, and unhyphenated codes are checked against common variants, so a match is found either way.
Estimate your report's position against the 25% reference line
Current checkout is test mode. Upload only an authorized PrimeRx or Caremark report without direct patient identifiers. PharmaFix calculates report-based rates and is designed not to retain report rows or results.