Pharmacy Benefit Managers (PBMs) play a critical role in maintaining and improving patient health, and the role continues to evolve within the healthcare industry. Shifting regulatory guidelines influence the expectations for the role as PBMs focus on delivering best in-class prescription products to manage patient conditions efficiently and achieve better health outcomes.
More than 275 million Americans rely on PBMs to manage their prescription drug benefits, making their role essential in our modern healthcare landscape. PBMs are responsible for processing and paying prescription drug claims, developing and maintaining the formulary, and negotiating discounts with drug manufacturers to achieve the best rates for patients. Therefore, it is crucial that PBMs maintain compliance with all program regulations to ensure the most accurate, cost-effective quality of care for their clients.
Traditionally, PBMs rely on complex and expensive software systems, most of which are outdated and lack technical support. Since many legacy systems don’t support the tasks conducted by PBMs, they spend a majority of their working hours routing tasks manually. All of this time and effort spent on manual tasks prevents them from achieving the best possible results for their clients.
Process automation solutions offer a comprehensive solution for PBMs to deliver optimal healthcare results. Since PBMs require a platform capable of integrating with healthcare systems and third-party applications used for billing, claims, and formulary management, a business process automation (BPA) platform like Decisions offers not only the integration capabilities to connect and orchestrate the disparate systems, but also streamline a PBM’s workload with its robust rules engine and workflow manager.
