Agentic AI for Pharmacy Operations

Automate Pharmacy Workflows, Reduce Claim Rejections, and Speed Reimbursement

Pharmacies face increasing operational complexity driven by payer rules, prior authorizations, and shrinking margins. XY.AI applies agentic AI to automate pharmacy operations across intake, eligibility, prior authorizations, claims, and reimbursement workflows.

Multimodal Browser Agent

Data Entry & Extraction

Missing Information & Errors

Patient Cost Estimator

Multimodal Browser Agent

Data Entry & Extraction

Missing Information & Errors

Patient Cost Estimator

Why Pharmacies Need AI-Driven Workflow Automation

Pharmacy operations depend on accurate, timely coordination across payers, PBMs, providers, and patients. Manual workflows create delays, rejections, and lost revenue.

Common Pharmacy Operations Challenges

Front-End Inefficiencies

Manual eligibility and formulary verification

Staff manually check coverage, copays, and formulary status across multiple payer and PBM portals

Prior authorization delays

Specialty and high-cost medications require time-consuming prior authorization processes

Incomplete prescription intake data

Missing patient information, prescriber details, or clinical documentation slows processing

Back-End Inefficiencies

Claim rejections due to NDC, coverage, or documentation issues

Incorrect NDCs, coverage gaps, and missing documentation lead to rejected claims and rebilling

Manual payment posting and reconciliation

Posting remittances and reconciling accounts is time-consuming and error-prone

Repetitive portal navigation across PBMs and payers

Staff spend hours logging into different portals to check status and resolve issues

Compliance documentation and audit preparation

Maintaining audit trails and compliance documentation adds administrative burden

These inefficiencies delay prescription fulfillment and impact patient adherence.

Pharmacy-Specific Agentic AI Use Cases

Automate the workflows that slow down pharmacy operations and delay patient care

Automated Eligibility & Formulary Verification

Agents verify coverage, copays, step therapy, and formulary status across payer and PBM portals.

Solves: Intake delays, coverage surprises, manual errors

Verify coverage across multiple payer and PBM portals
Extract copays, step therapy, and formulary status
Flag coverage issues before dispensing

Prior Authorization Automation

AI gathers clinical documentation, completes payer-specific forms, submits authorizations, and tracks responses.

Solves: Long turnaround times, staff burnout

Gather required clinical documentation automatically
Complete payer-specific PA forms
Submit and track authorization status

Pharmacy Claims Scrubbing & Submission

Agents validate NDCs, modifiers, coverage rules, and documentation before submission.

Solves: High rejection rates, rebilling workload

Validate NDCs and modifiers automatically
Check coverage rules before submission
Flag missing documentation

Payment Posting & Reconciliation

Automated remittance retrieval, matching, posting, and discrepancy detection.

Solves: Delayed reconciliation, missed underpayments

Auto-retrieve and post remittances
Match payments to claims automatically
Detect and flag underpayments

Portal Navigation & Document Handling

AI agents log into PBM and payer portals to upload documentation, download requests, and resolve issues.

Solves: Portal fatigue, slow resolution times

Navigate PBM and payer portals automatically
Upload required documentation
Download and process requests

Pharmacy-Specific Agentic AI Use Cases

Automate the workflows that slow down pharmacy operations and delay patient care

Automated Eligibility & Formulary Verification

Agents verify coverage, copays, step therapy, and formulary status across payer and PBM portals.

Solves: Intake delays, coverage surprises, manual errors

Verify coverage across multiple payer and PBM portals
Extract copays, step therapy, and formulary status
Flag coverage issues before dispensing

Prior Authorization Automation

AI gathers clinical documentation, completes payer-specific forms, submits authorizations, and tracks responses.

Solves: Long turnaround times, staff burnout

Gather required clinical documentation automatically
Complete payer-specific PA forms
Submit and track authorization status

Pharmacy Claims Scrubbing & Submission

Agents validate NDCs, modifiers, coverage rules, and documentation before submission.

Solves: High rejection rates, rebilling workload

Validate NDCs and modifiers automatically
Check coverage rules before submission
Flag missing documentation

Payment Posting & Reconciliation

Automated remittance retrieval, matching, posting, and discrepancy detection.

Solves: Delayed reconciliation, missed underpayments

Auto-retrieve and post remittances
Match payments to claims automatically
Detect and flag underpayments

Portal Navigation & Document Handling

AI agents log into PBM and payer portals to upload documentation, download requests, and resolve issues.

Solves: Portal fatigue, slow resolution times

Navigate PBM and payer portals automatically
Upload required documentation
Download and process requests

ROI of Agentic AI for Pharmacy Operations

Reduce rejections, accelerate reimbursements, and improve patient outcomes

40–60%

reduction in administrative labor

30–50%

reduction in pharmacy claim rejections

Faster

reimbursement cycles

Quicker

prescription fulfillment

Higher

patient adherence and satisfaction

Scalable

operations without additional staffing

Why Pharmacies Choose XY.AI

Designed for healthcare reimbursement complexity

Automates workflows even when APIs don't exist

Human oversight with autonomous execution

Unified analytics for operational ROI

Rapid, modular deployment across workflows

Ready to Transform Your Pharmacy Operations?

See how our AI Agents can automate your workflows, reduce claim rejections, and accelerate reimbursements.

Fast

Deploy in weeks, not months

Secure

HIPAA-compliant and SOC 2 certified

Scalable

Grows with your pharmacy business