A prescription has been filled. The patient has gone home. For a hospital’s pharmacy team, the transaction may still be unfinished. There is another question behind the counter: does this prescription qualify for a 340B discount, and can the organization document why?
The federal program’s requirements make that distinction consequential. Eligible providers must keep auditable records, prevent drugs from going to ineligible patients and prevent prohibited duplicate discounts. The work involves prescriptions, patient encounters, purchasing accounts and rules. A discount has a surprisingly large entourage.
- PharmaForce connects pharmacy claims with eligibility checks, purchasing and reporting.
- Its buyers are hospitals, health systems and clinics, rather than individual patients.
- Configurable tools and experienced operators are central to its pitch.
- Independent customer research makes the case for checking fit by care setting.
PharmaForce occupies this administrative middle ground. Its contract pharmacy offering combines claims qualification, manufacturer restriction management, reporting, financial analytics and workflow tools. The promise is that pharmacy teams can see exceptions and act on them before value slips away. It is a business built around making a transaction explain itself.
01 / The opportunity was already crowded
Co-founder Daniel Dimitri arrived with experience at Kaiser Permanente and McKesson. In a February 2025 interview, he described teaming up with a partner who supplied financial means and software resources. He then changed direction toward a pharmacy niche closer to the developers’ experience and his own claims background.
His interviews with health systems suggested dissatisfaction with existing vendors. Competition did not put him off. It helped persuade him that there was room for a better product. The early obstacle, in his account, was trust: getting the first customers to risk using a new provider. Once the company could supply three references, the sales conversation became easier.
There is a practical lesson here for anyone selling consequential software. The first customer supplies more than revenue. A credible reference reduces the next buyer’s uncertainty. A product can be technically finished and commercially unready; the missing component may be another customer willing to answer the phone.
02 / Follow the claim, including the awkward ones
Consider the prescription written by an outside specialist. A health system may recognize the patient, yet still need supporting records before treating the prescription as an eligible 340B claim. That is the territory of Referrals+: documentation outreach, eligibility review and a route back into claims processing.
The product combines switch data, configurable rules and human investigation. Integrated fax outreach requests provider notes. Teams can set encounter lookback windows, choose whether to capture subsequent refills and establish a minimum net-savings threshold. Customers may operate the queue themselves or buy a managed service. The fax survives because the evidence must come from somewhere.
- 01FlagOutside prescriber claim needs review
- 02DocumentObtain notes and review encounter evidence
- 03QualifyApply the entity’s eligibility controls
- 04ReprocessReturn approved claims to contract pharmacy
Inside the hospital, another problem appears: buying replacement inventory against the appropriate account. PharmaForce’s Split Billing supports two-way and three-way order splits, central distribution and site-level utilization tracking. Its mapping tools connect drug identifiers and charge codes; change logs preserve the configuration history.
That history matters. A team investigating a claim needs to know which rule applied at the time, not merely what the setting says today. The platform lets users manage exclusions and eligibility settings directly, generate claim-level self-audits and receive alerts about blocked transactions or unshipped orders. Those are modest-sounding features until someone asks why an order went where it did.
03 / Submission is not the finish line
ClaimsConnect addresses the next handoff: preparing and validating claims data, submitting it under differing reporting requirements, and tracking what happens afterward. Its advertised workflows cover manufacturer reporting, state Medicaid reporting and rebate-related processing.
The distinction between sending and settling is important. A file can leave a system without every claim being accepted. A claim can be accepted without its expected payment having arrived. Rejection reasons, payment tracking and reconciliation turn a reassuring green check into a more useful financial record.
This is also a changing market. In August 2026, HRSA announced a revised rebate pilot, with selected-drug rebate plans scheduled to take effect January 1, 2027. Under that approach, eligible claims are validated before rebates are paid. For affected transactions, the operational question expands from eligibility to timing: what was submitted, what was rejected and what remains unpaid?
A claim is only as useful as the trail that explains it.
An editorial reading of PharmaForce’s product strategy
04 / The hospital is also an employer
PharmaForce’s pharmacy benefit manager extends the proposition to self-insured healthcare organizations. A hospital can be both a provider with a 340B program and an employer paying for staff prescriptions. The PBM offers custom formularies and networks that can direct members toward the organization’s own pharmacies.
The company advertises “100% of manufacturer discounts passed to you” and an administration fee. Its combined TPA and PBM pitch centers on unified eligibility, claim capture and duplicate-discount protection. Employees still need to qualify under the applicable patient definition; employment alone does not make every prescription a 340B transaction.
There is a pleasingly concrete internal use case: PharmaForce says its own employee pharmacy benefits use its PBM. Its resources identify Birdi for home delivery and North Scripts for certain specialty prescriptions. That puts the company on both sides of its own service relationship.
05 / Fees deserve their own column
The economics require more care than comparing headline savings. PharmaForce’s public financial reporting guide distinguishes TPA per-claim or minimum fees, processing charges, gateway and transaction charges, referral-service fees and split-billing fees. These are contractual categories, not a universal price menu.
A buyer can copy the discipline implied by that ledger: evaluate net value after drug costs, pharmacy payments, service fees and the work left to staff. Ask which exceptions are included in the service. A claim that looks attractive in a gross-savings chart may be less exciting after all the people and systems involved have taken their seats.
06 / Growth has a customer-service bill
Aquiline’s majority investment closed in the fourth quarter of 2023 and was announced in January 2024. The announcement described more than 280 clients, a recently launched PBM and ambitions for product expansion and strategic acquisitions. Financial terms were undisclosed.
That expansion has a useful counterpoint. KLAS’s 2024 research found strong hospital experiences, while surveyed ambulatory customers reported more variable service, slower fixes and missed timelines. Their average satisfaction score was 12.5 points below that of acute-care respondents. Both groups still reported value and savings.
The gap between ambulatory and acute-care customer satisfaction in KLAS’s 2024 sample, on a 100-point scale.
A difference, not two absolute scores. Historical survey findings; not a verdict on every customer.Alternatives in this market include Verity Solutions, Macro Helix, RxStrategies and The Craneware Group. The sensible comparison begins with customers who resemble your organization. A small clinic and a multi-hospital system can buy the same vendor while needing very different attention. A historical award cannot answer that question for them.
07 / Ask the software why
The company’s current AI offering, Claire, is embedded in Contract Pharmacy 2.0 and Split Billing 3.0. It provides workflow guidance and can analyze authorized live program data. Its suggested questions concern blocked drugs, unmapped charge codes and accumulator balances. The ambition is to make operational answers easier to retrieve.
For a buyer, those questions make a useful demonstration script. Bring an exception, follow it through the system and ask for the supporting records. Then speak to a customer with the same care setting and staffing constraints. This approach tests both the technology and the service around it.
There is a firm boundary: the covered entity retains responsibility for its contract pharmacy arrangements. Software cannot supply missing clinical evidence by wishful thinking or make an ineligible claim eligible. PharmaForce’s usefulness rests on the less theatrical work of connecting records, rules and follow-up. In hospital finance, knowing exactly why the money is there can be as valuable as finding it.