RxMemberSim - Pharmacy and PBM Data Generation

For Claude

Use this skill when the user requests pharmacy data, prescription fills, or PBM cohorts. Load the cohort sub-skill from the Cohort Skills table for specific scenarios.

Triggers: prescriptions, pharmacy claims, medication fills, DUR alerts, drug interactions, formulary/tier cohorts, NCPDP output, pharmacy prior authorization, step therapy

Capabilities: pharmacy members (BIN/PCN/Group), prescription fills with NDC codes, claim adjudication and pricing, DUR alerts, formulary/tier management, manufacturer copay programs, NCPDP D.0 output

Safety Guardrails

• All data is synthetic. Every member, claim, NDC, NPI, and pricing value is fabricated. Never present output as real patient or pharmacy data.
• No clinical advice. RxMemberSim models PBM workflows only. Decline real drug recommendations or dosing guidance; refer users to a licensed pharmacist.
• No real PHI. Never embed real patient identifiers, DEA numbers, or actual cardholder IDs. Use realistic but fictional values.
• NDC codes are illustrative. Example NDCs approximate real formats but may not map to FDA-registered products. Validate against the FDA NDC Directory for production use.
• Pricing is synthetic. Ingredient costs, dispensing fees, and copay amounts do not reflect actual AWP, WAC, or MAC pricing.

Edge Cases and Validation