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AI-native medication adherence · For payers
PrefillX automates 80%+ of medication refill approvals and turns adherence into measurable QBP dollars — for Medicare Advantage plans serving 100K+ lives.
HIPAA aligned · SOC 2 Type II in progress · FHIR R4 + NCPDP SCRIPT.
PDC ≥ 80% across MAC, MAD, and MAH — measured monthly, banked annually.
Designed for Medicare Advantage plans, ACO partners, and the pharmacy networks that serve them
QBP uplift calculator
Drag the inputs to model your benchmark. Results update live and use the same math we publish on /methodology.
State is saved in the URL — share it with finance.
Projected Stars after 12 months
3.5 → 4.0
Modelled at $1,150 PMPM benchmark and 65% rebate share1. Plan-specific results depend on bid, region, and CMS rate announcement.
How it works
Pharmacists own the decisions that matter. PrefillX automates the routine path and keeps the audit log complete to four nines.
Step 1
Refill request lands via NCPDP SCRIPT or EHR webhook. We hash, classify, and queue in under one second.
Step 2
Reasoning model runs the 20-point clinical protocol; routine paths auto-approve, edges escalate with full trace.
Step 3
Pharmacists see only escalations, ordered by adherence risk. Every reasoning trace is a one-click expand.
Step 4
Approved refill returns to the pharmacy via SCRIPT; member adherence is logged against MAC, MAD, MAH.
Case studies
Detailed write-ups available with a work email — or skip the gate to read the summaries below.
How a regional plan rerouted 4,200 weekly refills through the AI triage and unlocked $4.1M in QBP within twelve months.
A 38K-life ACO used PrefillX to pre-clear refills before the QBP cut, lifting closure rate by 22% and capturing shared savings for the first time.
Pharmacists shifted from triage to escalation review only. Throughput rose without backfill; clinical safety metrics held flat.
Integrations
FHIR R4 reads against MedicationRequest, Patient, Observation. SMART on FHIR launch for in-EHR review. Bidirectional with the four EHRs that cover 80% of MA lives.
Built on the HL7 + NCPDP specs your interop team already audits.
Outbound RefRes routes through your existing prescribing network — no new pharmacy integrations required.
Pricing
Pricing is sized to QBP uplift — not API call volume. We share the model openly on the readout call.
Frequently asked
Book a readout
We share the QBP math for your specific bid, region, and rebate share. No deck — just a working spreadsheet you keep.