Smarter Recoveries. Seamless Compliance. Maximum Value.

Machinify recovers the pharmacy dollars your current processes miss, faster, more accurately, and with measurable ROI.
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The Pharmacy Payment Integrity Gap Is Underrated and Expensive

Pharmacy payment accuracy is often overlooked in favor of medical claims but the risk is just as high. COB confusion, member terminations, and Part D audit panic cost plans millions each year. With no reversals allowed and provider outreach strained, recovery often feels impossible.

Machinify closes these gaps with purpose-built, low-abrasion pharmacy PI solutions. Download our pharmacy solution guide to learn more about Machinify's pharmacy solutions.  

Download Our Pharmacy Solution Guide

Pharmacy PI Solutions

Real Results, Real Fast

What Health Plans Achieve with Machinify

  • $70M+ recovered and preserved in Medicare Part D subsidies
  • 350% boost in pharmacy Retro Term recoveries
  • $10M+/month recovered by top-tier payers
  • 80% of retro term recoveries billed to other coverage, not the member
  • Under 100-day median cycle time to cash

Top plans report 5–15X ROI within the first year

Unlock Your Pharmacy Recovery Opportunity
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Recover Millions in Pharmacy Overpayments - Faster, Smarter, and with Less Friction

With over 100 specialized pharmacy payment analysts and a 12-year average client tenure, we bring unique and trusted expertise to support payers with:

  • Pharmacy Coordination of Benefits
  • Pharmacy Retroactive Terminations
  • Medicare Part D Compliance
  • High-Cost/Specialty Drug Management

The numbers speak for themselves

60+
CMS One-Third Financial Audits supported
4 of 6
of the nation's largest payers use Machinify for Rx COB
1-2%
savings of total drug spend delivered

Solutions that Scale with You

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Pharmacy Coordination of Benefits (COB)

Reclaim overpayments missed by legacy vendors with payer-to-payer validation.

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Retroactive Terminations

Recovers claims paid after member termination, often by rebilling to new coverage. 
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Medicare Part D Compliance

Ensures compliance with CMS requirements while maximizing subsidy retention and overpayment recovery. 
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High-Cost Specialty Drug Management

Prioritizes most likely overpaid drug claims, identifies claim overpayments, confirms incorrect billed claims, and recovers overpayments.

Useful Pharmacy Resources

Blog: Q&A About Pharmacy Payment Integrity

At Machinify, we’re always looking for new ways to bring clarity to complex payment integrity challenges and pharmacy is no exception. Chris Powers, VP of National Sales, sat down with Derek McMahan, SVP of Pharmacy to answer the industry’s most pressing questions. 

Read Blog

Case Study: 378% Gain in Pharmacy Recoveries with Machinify Retro Term

See how a national health plan achieved 378% pharmacy overpayment recovery growth with Machinify's retro term solution.

Download Case Study

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