pharmacy-benefits-specialist

pharmacy-benefits-specialist is an agent for Claude Code from ajhcs/healthcare-agents. It costs 33 tokens per session (7,309 once invoked), scanned A, original, Apache-2.0.

A pharmacy-benefits specialist focused on drug formularies, pharmacy-benefit managers (PBMs), specialty medicines, rebates, and biosimilars.

In plain words
What is it for?
Use it for formulary decisions, PBM contract strategy, specialty-pharmacy programmes, biosimilar adoption, benefit design, medication-management services, and drug-spend analysis.
Why use it?
It helps assess how medication coverage decisions affect clinical care, patient costs, and an organisation’s drug spending.

Agent for Claude Code

Written for Claude Code: a Claude Code subagent (agents/*.md). Also seen: positional $N argument.

Good fit Use it for formulary decisions, PBM contract strategy, specialty-pharmacy programmes, biosimilar adoption, benefit design, medication-management services, and drug-spend analysis.

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Install with agentmods
npx agentmods add agents/ajhcs/healthcare-agents/pharmacy-benefits-specialist
Install

Getting it into your agent

One page per mod, every tool's command on it. A separate URL per tool would split the same page into five that compete with each other.

Clone the repo
git clone --depth 1 https://github.com/ajhcs/healthcare-agents

Made for: Claude Code.

Wrote this? Show the measurements

A badge with what this costs and how it scanned, read live from this page, so it follows the numbers instead of freezing them. Markdown for a README, HTML for a documentation site or a project page.

agentmods badge for pharmacy-benefits-specialist

README.md
[![agentmods](https://agentmods.dev/badge/agents/ajhcs/healthcare-agents/pharmacy-benefits-specialist/github.svg)](https://agentmods.dev/agents/ajhcs/healthcare-agents/pharmacy-benefits-specialist)
Your own site
<a href="https://agentmods.dev/agents/ajhcs/healthcare-agents/pharmacy-benefits-specialist"><img src="https://agentmods.dev/badge/agents/ajhcs/healthcare-agents/pharmacy-benefits-specialist/github.svg" alt="Measured on agentmods" height="20"></a>

Or the 80×15 button, for a site that already has a row of RSS and ATOM ones. Only the verdict fits; the numbers stay here.

agentmods 80×15 button for pharmacy-benefits-specialist

Your own site · 80×15
<a href="https://agentmods.dev/agents/ajhcs/healthcare-agents/pharmacy-benefits-specialist"><img src="https://agentmods.dev/badge/agents/ajhcs/healthcare-agents/pharmacy-benefits-specialist.svg" alt="Reviewed on agentmods" width="80" height="20"></a>
Per session 33 Only the description is in the session, so the agent can decide to use it. The body loads when it is invoked.
When invoked 7,309 The whole file, excluding the scripts and references it only reads on demand.
Security scan A 0 findings. A grade says what 26 rules found in the file — not that it is safe.
Origin original No closer match found in the catalogue.
Token cost

What it costs to keep this loaded

Counted locally with the o200k_base tokenizer, which is exact for GPT models; Claude uses its own tokenizer and its counts differ. Treat this as one consistent yardstick across the catalogue rather than a bill. Prices are per million input tokens.

ModelPer sessionOnce invoked
Fable 5.1 $0.00033 $0.07309
Opus 5 $0.00016 $0.03655
Sonnet 5 $0.00007 $0.01462
Haiku 4.5 $0.00003 $0.00731

Measured 12d ago against content hash 19d69bc6529e, method: parsed. Prices are Anthropic first-party input rates as of 2026-09-12, from the pricing page.

Security

Grade A, and why

pharmacy-benefits-specialist scanned grade A with 0 findings against 26 rules in 11 categories — prompt injection, anti-refusal, data exfiltration, privilege escalation, supply chain, agent snooping, system-prompt leakage, SSRF and excessive agency — measured 12d ago.

A static scan of the body, not an audit. Every finding is printed with the line that produced it so you can judge whether it matters here. A mod is markdown that instructs an agent; that is exactly why what it instructs is worth reading.

Nothing flagged

None of the 26 patterns this scan looks for appear in this file: no shell pipes, no recursive deletes, no credential paths, no hidden text, no instruction-override or anti-refusal phrasing, no agent-config snooping. That is not a guarantee, it is the absence of the things that are checkable.

agents/pharmacy-benefits-specialist.md · 457 lines

How it starts

The opening of the file, as written. The whole thing — 457 lines — stays where its author put it; the contents beside it link to each section on GitHub.

Pharmacy Benefits Specialist

You are PharmacyBenefitsSpecialist, a senior pharmacy benefits strategist with 12+ years managing formulary operations, PBM relationships, and pharmacy benefit design across integrated delivery networks, self-insured employers, and managed care organizations. You've chaired P&T committees, negotiated PBM contracts worth nine figures in annual drug spend, built biosimilar conversion programs that saved health systems millions, and redesigned benefit structures that reduced member cost burden while improving medication adherence. You operate at the level of someone who has been a PharmD with an MBA overlay — you understand the clinical pharmacology AND the financial engineering behind every formulary decision.

🧠 Your Identity & Memory

  • Role: End-to-end pharmacy benefits management — formulary governance, PBM contract strategy, specialty pharmacy program design, biosimilar adoption, benefit architecture, MTM services, and drug spend analytics
  • Personality: Analytically rigorous but commercially pragmatic. You know that every formulary decision is a three-way negotiation between clinical evidence, patient access, and financial sustainability. You speak in specifics — NDCs and GCNs, not "drugs"; PMPM impact, not "savings"; rebate effective rates, not "discounts."
  • Memory: You remember common PBM contract traps (spread pricing, DIR fee clawbacks, narrow MAC list manipulation), the evolution of specialty pharmacy from niche to 50%+ of drug spend, biosimilar launch sequencing, and which benefit design levers actually move adherence versus just shift cost.
  • Experience: You've unwound a PBM contract where spread pricing was costing the plan $4M annually in hidden margin. You've built a biosimilar conversion program for adalimumab that achieved 87% switch rates in 6 months. You've redesigned a commercial formulary from 3 tiers to 5 tiers with value-based copay structures tied to chronic disease adherence. You've managed a specialty pharmacy carve-out that brought $12M in annual drug spend in-house.

Read the full file on GitHub · 457 lines

Changes

What this file has done since we first saw it

Hashed on every crawl. A supply-chain change to an agent config is a question of when, not whether, so the history is kept rather than the latest state alone.

  1. 12d ago First seen · 457 lines · 33 tokens per session scan A 19d69bc6529e

Subscribe to this mod's changes

pharmacy-benefits-specialist is an agent published in the GitHub repository ajhcs/healthcare-agents (51 stars, last pushed 1mo ago), licensed Apache-2.0. It adds 33 tokens to every session and 7,309 once invoked, about $0.0002 per session on Opus 5. A static security scan graded it A with 0 findings. No closer match exists in the catalogue, so it is treated as the original; first seen 2026-08-30.

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