Answers About Independent
PBM Oversight
What Stratos does, what independent oversight actually tests, and how claims-level analysis applies to public budgets, health plans, and pharmacy margins. If your question is not here, ask us directly.
About Stratos Insights.
What is Stratos Insights, and what does Stratos do?
Stratos Insights is an independent reimbursement oversight and analytics firm that provides PBM oversight, reimbursement integrity, and claims-level visibility. Stratos serves public sector stakeholders, private sector health plan sponsors, and pharmacy organizations, turning complex claims and reimbursement data into clear, defensible insight that supports financial accountability and profitability visibility. Stratos Insights is part of the PPOK family of pharmacy companies.
Is Stratos a PBM?
No. Stratos is not a pharmacy benefit manager. Stratos provides independent reimbursement oversight and claims-level analysis. Stratos helps organizations better understand PBM reporting, reimbursement behavior, and financial outcomes, but it does not administer pharmacy benefits, process claims as a PBM, or manage formularies.
Does Stratos provide contract negotiation services?
No. Stratos does not position itself as a contract negotiation service and does not negotiate contracts on a client's behalf. Stratos focuses on independent reimbursement visibility, claims-level analysis, PBM oversight, and profitability intelligence.
Who owns Stratos Insights?
Stratos Insights is part of the PPOK family of pharmacy companies. Stratos operates as an independent reimbursement oversight and analytics firm, providing claims-level visibility and PBM oversight to public sector, private sector, and pharmacy clients.
Is Stratos independent if it is part of a larger pharmacy organization?
Stratos provides analysis that is independent of the PBMs and payers whose reimbursement it reviews. It has no financial stake in the reimbursement outcomes it analyzes and does not negotiate contracts.
PBM Oversight and Reimbursement Integrity.
What is the difference between a PBM report and independent reimbursement oversight?
A PBM report is prepared by the PBM and typically shows selected performance measures. Independent reimbursement oversight, such as the analysis Stratos Insights provides, examines the underlying claims data to test whether reimbursement behavior and financial outcomes actually match expectations. The difference is independence and claims-level detail.
How does Stratos support reimbursement visibility?
Stratos analyzes claims activity, reimbursement behavior, payer performance, and cost data to help organizations understand financial performance at a more granular level. This claims-level approach reveals patterns, such as below-cost claims, spread pricing exposure, and reimbursement trends, that summary reports typically do not surface.
Does Stratos replace our existing reporting?
No. Stratos complements existing reporting by adding an independent, claims-level layer of validation and visibility. Organizations use Stratos to confirm what their PBM or payer reports are telling them and to surface patterns, like below-cost claims or spread pricing exposure, that summary reports often miss.
How does Stratos protect claims and reimbursement data?
Stratos handles claims and reimbursement data inside a SOC 2 Type 2 environment, with security controls built for sensitive healthcare and financial information. Data is used solely for independent analysis on behalf of the client organization, so the resulting insight is both defensible and responsibly managed.
Answers for Public Sector Stakeholders.
How does Stratos support public sector stakeholders?
Stratos helps public sector stakeholders, including attorney general offices, offices of inspector general, insurance commissioners, state associations, and public employee health plans, evaluate reimbursement integrity, below-cost claims, PBM reporting patterns, and financial accountability tied to government budgets and taxpayer dollars. Stratos provides an independent fact base rather than PBM-supplied summaries.
How can a state agency independently verify PBM reimbursement?
A state agency can independently verify PBM reimbursement by analyzing claims-level data rather than relying solely on PBM-supplied summary reports. Stratos Insights performs this independent, claims-level analysis for public sector stakeholders, examining reimbursement behavior, below-cost claims, and rebate and spread pricing patterns to build a defensible, independent fact base.
What are below-cost claims and why do they matter to public budgets?
Below-cost claims occur when a pharmacy is reimbursed less than the acquisition cost of a drug. At scale, patterns of below-cost reimbursement can signal reimbursement integrity issues that affect pharmacy sustainability and public program spending. Stratos helps public sector stakeholders identify and quantify below-cost claim activity within their programs.
Answers for Employers and Health Plans.
How does Stratos support employers and health plans?
Stratos helps private sector organizations, including self-insured employers, commercial health plans, and Medicaid MCOs, gain visibility into PBM performance, spread pricing, rebate validation, claims transparency, and plan cost management through independent, claims-level analysis.
How can a self-insured employer tell if its PBM is using spread pricing?
A self-insured employer can detect spread pricing by comparing what the plan is charged against what the pharmacy is actually reimbursed at the claim level. Stratos Insights performs this independent, claims-level analysis to quantify spread pricing exposure and validate whether rebate and pricing terms are being honored.
What is rebate validation and why does it matter?
Rebate validation is the process of independently confirming that the manufacturer rebates a plan is owed are calculated, passed through, and reconciled correctly. Stratos helps private sector organizations validate rebate performance against expectations using claims-level data, so plan sponsors can see whether they are receiving the value their contract promises.
Answers for Pharmacy Organizations.
How does Stratos help pharmacy organizations improve profitability?
Stratos helps multi-location pharmacy groups, GPOs, and warehouse operators understand true profitability at the claim level. Through its ScriptWise platform, Stratos surfaces payer performance, reimbursement trends, margin leakage, and a Top 10 list of prioritized profitability opportunities.
How can a pharmacy see its true profitability by payer?
A pharmacy can see true profitability by payer by analyzing reimbursement against acquisition cost at the individual claim level, then grouping results by payer and plan. Stratos Insights delivers this through its ScriptWise platform, which surfaces payer performance, margin leakage, and a Top 10 list of prioritized profitability opportunities.
What is ScriptWise?
ScriptWise is Stratos Insights' pharmacy analytics platform. It delivers dynamic, claims-level profitability visibility and prioritized operational insight, including loss mitigation analysis, payer performance visibility, reimbursement trend visibility, preferred therapy opportunities, adherence impact, and a Top 10 list of the highest-value opportunities across a pharmacy's operations.
Still Have a Question About Your Claims Data?
Start with an independent, claims-level look at reimbursement performance, in clear, defensible terms your team can act on.