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healthsim-rxmembersim

Generate synthetic pharmacy data for PBM claims adjudication and DUR validation.

1|Updated Jan 9, 2026
Search Tags:#generate#claims#pharmacy#formulary#DUR#PBM#PA
One-click install
npx skills add https://github.com/mark64oswald/healthsim-agent --skill healthsim-rxmembersim
Or copy as Structured Prompt for Agent▼
Please help me install this Agent Skill.
Skill: healthsim-rxmembersim
Source: https://github.com/mark64oswald/healthsim-agent/tree/main/skills/rxmembersim
Command: npx skills add https://github.com/mark64oswald/healthsim-agent --skill healthsim-rxmembersim

SYSTEM DOCUMENTATION & REQUIREMENTS

What problem does it solve?

This Skill enables realistic synthetic pharmacy data generation to test PBM systems, claims adjudication, and DUR logic without exposing real PHI.

Core Features & Use Cases

  • Generate RxMemberSim entities (RxMember, RxPlan, RxAccumulator, Prescription, PharmacyClaim) and associated responses for comprehensive PBM testing.
  • Model DUR alerts, formulary structures, prior authorizations, manufacturer programs, and copay dynamics across multiple cohorts.
  • Integrate with HealthSim cross-product workflows (PatientSim, MemberSim) for end-to-end testing of pharmacy and medical plans.

Quick Start

Use healthsim-rxmembersim to create a retail pharmacy fill and a corresponding NCPDP D.0 claim example; then export as JSON for API testing, or CSV/SQL for analytics.

Frequently Asked Questions about healthsim-rxmembersim

High-intent search queries and answers about installing and using this skill.

FAQPage Schema
How do I generate synthetic pharmacy claims data for PBM testing without using real PHI?▼

You can generate synthetic pharmacy claims data for PBM testing without exposing real PHI by creating realistic RxMember entities, Prescription records, and PharmacyClaim responses across multiple cohorts.

Can I simulate DUR alerts and prior authorization logic for claims adjudication testing?▼

Yes, you can simulate DUR alerts, prior authorizations, and formulary structures to validate claims adjudication logic and copay dynamics across synthetic pharmacy cohorts.

What is the best way to model NCPDP D.0 claims for retail pharmacy fill testing?▼

The best way to model NCPDP D.0 claims for retail pharmacy fill testing is to generate retail pharmacy fill examples and export them as JSON for API testing or CSV/SQL for analytics.

Does RxMemberSim work with medical plan data for end-to-end cross-product testing?▼

RxMemberSim integrates with HealthSim cross-product workflows like PatientSim and MemberSim to test pharmacy and medical plans together in end-to-end cross-product workflows.

What formats can I export synthetic pharmacy data into for analytics and API validation?▼

You can export synthetic pharmacy data into JSON for API testing, or CSV and SQL formats for analytics, ensuring flexible validation of PBM systems and claims adjudication workflows.

What pharmacy entities do I need to model for comprehensive PBM formulary and accumulator testing?▼

You need to model RxMember, RxPlan, RxAccumulator, Prescription, and PharmacyClaim entities to test formulary structures, manufacturer programs, and copay dynamics comprehensively.

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