Reimbursement integrity
Whether reimbursement behavior across the program actually aligns with expectations, tested against the claims themselves.
Public sector
Independent Visibility for Public Accountability
Stratos Insights gives attorney general offices, inspectors general, insurance commissioners, state associations and public employee health plans an independent, claims-level fact base on PBM activity. Stratos tests reimbursement integrity, below-cost claims, PBM reporting patterns and pricing and rebate behavior against the claims themselves, so findings hold up in front of boards, legislators and taxpayers.
An independent claims-level analysis, not PBM-supplied summaries.The Stratos discipline
Who We Support
Built for the Offices Accountable to the Public.
Attorney general offices
Offices of inspector general (OIGs)
Insurance commissioners
State associations
Public employee health plans
Key Challenges We Address
Where Public Pharmacy Spend Gets Hard to See.
Reimbursement and PBM activity shape public program spending long before it reaches a summary report. These are the pressures Stratos is built to bring into view at the claim level.
- PBM reporting without independent validation
- Below-cost claims
- Opaque rebate structures
- Spread pricing concerns
- Rising prescription drug spend
- Public and legislative scrutiny
- Stewardship of taxpayer dollars
An Independent Fact Base
Built for the Scrutiny Public Spending Invites.
Public pharmacy spend is examined by boards, commissioners and taxpayers. Stratos analyzes the claims themselves, so the picture holds up when someone asks how you know.
How Stratos Helps
Independent, Claims-Level Reimbursement Analysis for Public Funds.
Stratos provides independent, claims-level reimbursement analysis to help public sector stakeholders better understand reimbursement integrity, PBM reporting patterns, below-cost claim activity, pricing and rebate visibility, and the governance and financial accountability tied to public funds.
PBM reporting patterns
What PBM-supplied summaries show, and what the underlying claims-level activity shows alongside them.
Below-cost claim activity
Where pharmacies are reimbursed below acquisition cost, and how that activity accumulates across a program.
Pricing and rebate visibility
How pricing and rebate structures behave in practice, quantified from claims rather than described in summary.
Governance and financial accountability
Reporting clear enough for leadership and legislative audiences, and defensible enough to hold up under scrutiny.
Taxpayer stewardship
An independent fact base for decisions about government budgets and the public dollars behind them.
Related
Where This Connects.
Frequently Asked Questions
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.
Ready to Build an Independent Fact Base Around Public Pharmacy Spend?
Start with an independent, claims-level look at reimbursement performance, in clear, defensible terms your office can act on.