PBM contracts and true-ups are opaque by design. Asepha Prism reveals the full spectrum of performance and margin exposure—turning DIR uncertainty into predictable outcomes.
Powered by Asepha-AI predictive intelligence.
Under CMS's 2024 rule, Medicare Part D plans must apply pharmacy price concessions at the point of sale (POS). But most commercial and managed-care networks still assess DIR fees retrospectively through end-of-period true-ups. Asepha Prism gives PSAOs and independents continuous visibility—no more waiting for opaque portal exports or year-end letters.
vs. final true-ups in pilots
median annualized estimate
when coaching actions followed
Note: CMS requires POS DIR only for Medicare Part D; commercial plans may still apply retroactive DIR.
PSAOs seldom see claims in real time, but they receive regular PBM portal exports, performance feeds, and optional pharmacy claim copies. Asepha Prism unifies those sources—creating a near-real-time view of DIR exposure across every contract and store.
Pulls weekly or daily files from PBM portals, switch partners, or pharmacy management systems.
The Contract Intelligence Agent (CIA) extracts DIR rules, performance tiers, and fee caps from every PBM agreement.
The DIR Fee Analyzer (DFA) combines current metrics with contract rules to forecast POS withholds and end-of-period true-ups.
Dashboards surface at-risk pharmacies, quantify dollar impact, and recommend corrective actions before reconciliation.
Forecast accuracy validated across 3 PBM networks and 2,000+ stores—using existing PSAO portal feeds and claim extracts.
Aggregate performance across member stores
Flag at-risk contracts before reconciliation
Export negotiation packs in one click
See projected DIR & true-up impact by claim
Improve adherence & GDR with guided steps
Generate audit / appeal packs instantly
Asepha Prism was designed for enterprise deployment. Embed the forecasting dashboard directly inside your PSAO portal, or deliver it as a white-labeled analytics suite under your own brand.
Okta, Microsoft Entra ID, Google Workspace
Integrate contract, claim, and DIR metrics into existing PSAO dashboards
Customize logo, color palette, and domain to present Prism as your own solution
Cloud, hybrid, or Asepha-managed pilot environments
Trusted by PSAOs and enterprise pharmacy networks adopting predictive DIR intelligence under their own brand.
Secure read-only access to contract + performance data
Optional portal export integration
Configurable data retention and local mock demo mode
HIPAA / BAA-ready infrastructure
No patient identifiers stored in demo mode.