Solutions for Health Plans & Health Systems

Independent pharmacy benefit expertise to help you optimize performance, reduce complexity, and deliver better outcomes.

Health plans and health systems face constant pressure to improve member outcomes, manage rising pharmacy costs, navigate regulatory changes, and execute complex initiatives. ALTTRAX provides the operational, clinical, and strategic expertise to help you move forward with confidence. Explore our services below to learn how we support assessments, implementations, audits, performance improvement, pharmacy oversight, AI initiatives, and other critical business priorities.

Strategic Program Acceleration

At ALTTRAX, we specialize in strategic program acceleration, providing expertise and bandwidth to enhance and expedite execution. Here’s how we can support your PBM, healthcare, or other business:

DEVELOPMENT AND IMPLEMENTATION OF STRATEGIES

We work closely with your team to develop and implement strategies that drive efficiencies and remove barriers to success. By leveraging our PBM, pharmacy, and healthcare expertise, we help you better execute projects and achieve your business objectives effectively.

SCALING YOUR BUSINESS

If you’re looking to scale your business but unsure where to start, we’ve got you covered. Our team will assess your needs, define a strategic plan, and quickly deliver better business results. With our support, you can scale faster and achieve more with less.

With ALTTRAX, you can accelerate your strategic programs, scale your business efficiently, and access top talent to drive your organization’s success.

Audits

Audits

Through our modern audit management platform, we deliver a custom and comprehensive auditing experience to help you identify discrepancies and discover optimization opportunities.

We offer a range of pharmacy audit services, with a focus on PBM, Medicaid, and 340B audits.

CUSTOMIZED AUDITING PROCESS

Using our modern platform, we conduct a 100% claim level review by channel and drug definition. This meticulous review ensures adherence to the pricing terms, calculations, guarantees, and exclusions outlined in your contract. By identifying any discrepancies, we help you optimize your pharmacy benefit program.

REBATE ANALYSIS

We conduct a comprehensive analysis of rebates based on your contract terms. The audit includes a detailed review of rebate contracts and invoices to ensure proper rebate payments.

ANNUAL MARKET CHECKS

Our annual market checks provide ongoing financial oversight and ensure market competitiveness throughout the duration of your contract. By staying informed about market trends and changes, we help you make informed decisions and optimize your pharmacy benefit program effectively.

With ALTTRAX, managing pharmacy benefit audits has never been easier. Let us simplify the pharmacy audit process and help you uncover valuable optimization opportunities for your organization.

ALTTRAX + AI: Smarter Solutions That Empower People

Practical, proven AI that strengthens your teams and elevates member experience.

ALTTRAX is bringing a powerful new capability to help organizations gain traction: artificial intelligence (AI). AI powers everything from online shopping to customer service chatbots—and now, it offers new ways to work faster, smarter, and more efficiently. Tools like ChatGPT and Google Gemini are familiar, but many organizations aren’t sure how AI best supports complex healthcare environments. That’s where ALTTRAX comes in.

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ALTTRAX is introducing a powerful new capability that helps organizations gain traction: artificial intelligence. We combine deep pharmacy expertise with proven AI solutions to make teams faster, smarter, and more effective without replacing people.

AI supports teams by providing real-time insights, simplifying complex information, and accelerating decision making. Imagine a customer service representative instantly understanding how a claim was processed and explaining it in plain language. That’s the kind of efficiency AI makes possible.

Other organizations offer AI, but they can’t match our combination of:

  • Deep pharmacy benefit expertise
  • Practical operational experience
  • A consultative, not sales-driven approach

We’re not here to sell multi-year engagements. We focus on quick, effective solutions that deliver measurable ROI.

Contact ALTTRAX to schedule a Rapid Assessment. We’ll help you determine whether AI is the right fit and outline a clear, actionable path forward.

No. Our approach empowers people, not replaces them. AI handles repetitive processing so teams can focus on higher-value work that requires judgment, empathy, and expertise.

Organizations often face:

  • Complex pharmacy benefits
  • Increasing member expectations
  • Service teams stretched thin

ALTTRAX can deliver AI solutions to streamline operations and help you deliver exceptional customer and member experiences.

We provide clarity: insight through assessment, direction through a clear roadmap, and simplicity through vetted, easy-to-implement solutions, all designed to deliver proven ROI.

Examples of tools we help organizations deploy include:

  • Real-Time Agent Assist: Instant answers for customer service agents
  • Accent Neutralization: Improves clarity and communication
  • Real-Time Translation: Supports conversations with non-English-speaking members
  • AI Agents: Reduce administrative workload associated with member inquiries, prior authorizations, and appeals

These tools integrate securely and can be tailored to your operation.

AI solutions are compliant with industry data-security standards and provide real-time insights without exposing sensitive information. Your data stays within your control, providing peace of mind.

We start by reviewing your AI roadmap or helping you build your first one. Through Rapid Assessments, interviews, and observation, we identify improvement opportunities. AI is recommended only when it meaningfully supports your goals.

Implementations can take as little as two weeks, depending on readiness and scope. ALTTRAX focuses on speed-to-value so you see results quickly.

ALTTRAX AI solutions are ideal for:

  • Health plans
  • TPAs
  • Brokers
  • Healthcare service organizations

Anyone looking to improve contact center performance or navigate complex pharmacy benefits will benefit from our approach.

Implementations

Whether you’re adopting a traditional PBM model or embracing a modular approach, implementation is the make-or-break phase. ALTTRAX doesn’t just consult. We roll up our sleeves and deliver. From vendor selection to operating workflows, from contracting to compliance, we’re with you every step.

Traditional PBM model: A single pharmacy benefit manager provides all core services under one bundled contract — claims processing, network management, mail order, specialty, and clinical programs. It’s simpler but less flexible.

Modular PBM model: Functions are unbundled and handled by multiple specialized vendors (e.g., one for claims, another for mail, another for clinical). It requires more management but offers greater customization, stronger control, improved transparency, and the potential for substantial cost savings.

See this short story that outlines our approach and this post about the modular model.

Discover and Assessment

We begin by understanding where you are: your current PBM setup, gap areas, vendor landscape, cost exposures, and risk.

Model Design and Planning

We help you choose your desired configuration — traditional, modular, etc. and identify dependencies, integration points and more.

Vendor Selection & Contracting

We assist in evaluating vendors, defining SLAs, negotiating contract terms, ensuring interoperability and accountability.

Implementation & Integration

Systems, claims flows, network relationships, clinical tools — we execute and coordinate all moving parts.

Testing, Training & Go-Live

Comprehensive end-to-end testing. Ensuring your team and vendors are ready. Smooth transition to operational performance.

Monitoring & Continuous Improvement

Post-launch oversight: performance metrics, compliance, vendor reviews, refinements to optimize savings and clinical outcomes.

What Sets Us Apart

  • Deep expertise: decades in PBM operations with multiple full-scale implementations under our belt.
  • Proven track record: delivering results and solving issues many others underestimated.
  • Balanced approach: no vendor bias, focused on outcomes. We are INDEPENDENT.
  • Transparent metrics and accountability: baked into every phase.

Let’s Talk!

Ready to launch your PBM implementation with precision and confidence? Contact ALTTRAX for a free consultation to explore whether modular, traditional, or hybrid implementation is your smartest path forward. See our contact information at the top of this page.

Rapid Assessment

PHASE 1:

UNDERSTANDING CURRENT STATE

We begin by reviewing documentation, process flows, policies and procedures, job descriptions, client surveys and feedback, key business metrics, org charts, sales material, and more.

PHASE 2:

TARGETED INTERVIEWS

We will meet individually with critical stakeholders and subject matter experts (SMEs) for 30-60 minutes. We also establish trust with individuals by reinforcing purpose and ensuring anonymity.

PHASE 3:

OBSERVATIONS

We then document and share observations with sponsor and owners and provide applicable feedback to peripheral parties / stakeholders.

PHASE 4:

RECOMMENDATIONS

Our final report includes a summary of scope, ALTTRAX’s approach, and artifacts.

Sample Rapid Assessment Report

Our Rapid Assessment services are available for PBM, pharmacy, and other healthcare companies and situations.