Milligram Health

● Initializing systems

Where we work

PBMs & Payers

Formulary, network, and reimbursement intelligence.

Decision SystemsData Platforms

We build the economic models and decision systems behind formulary, network, rebate, and reimbursement choices — grounded in pharmacy operational reality.

/ 01 The problems

What you're up against

Formulary and rebate decisions with enormous downstream impact
Network and MAC pricing that's hard to optimize
Medicare Part D and STARS complexity
Clinical and financial trade-offs made at scale
/ 02 The decisions

Decisions we help you make

These problems resolve into a small number of consequential decisions that are expensive to get wrong. These are the ones we help you make.

01What does this formulary change cost downstream — not just on paper?
02Where is the network mispriced, and what happens when you correct it?
03Which rebate structure still wins after operational reality is priced in?
04Which STARS investments move the rating, and which just move money?
/ 03 How we think

PBM and payer decisions move billions of dollars and touch millions of patients. We build the economic models and decision systems behind formulary, network, rebate, and reimbursement choices — grounded in pharmacy operational reality, not just claims math. The goal is to make the trade-offs explicit before they play out in the market.

/ 04 How we engage

We start with a specific, high-leverage decision — a formulary or network question — model it rigorously, and then build it into an ongoing capability.

At this scale, the risk is rarely the math itself — it is the downstream consequences the math doesn't show. We build the models that make those consequences visible before you commit.

/ 06 What's possible

Outcomes we build toward

Formulary and rebate decisions with clear downstream visibility
Optimized network and MAC pricing
Stronger Medicare Part D and STARS performance
Clinical and financial trade-offs made explicit

Focus areas

Formulary development & impactRebate & trade modelingNetwork & MAC pricingMedicare Part D & bid supportQuality & STARSClinical operations analytics

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