Payers require specialized solutions to effectively manage their pharmacy benefit programs. In today's market, being able to move quickly and having immediate access to information is necessary to design profitable programs, predict outcomes and manage relationships. Many PBMs are still challenged with waiting hours and days for pharmacy benefit changes to take effect. In addition, low (Prescription Drug Event) PDE acceptance rates are increasing the frequency of Centers for Medicare & Medicaid (CMS) audits and loss of payments.

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Gain complete control of your pharmacy benefit management tools

For more than two decades, RelayHealth's Prospective Health Services has developed and implemented technology solutions for pharmacy benefit management organizations.  These solutions give organizations like yours total control over your pharmacy benefit design and claims processing.

Our ProPBM™ platform is an efficient and flexible way for you to design, test and implement pharmacy benefit programs for your organization, giving you access to any pharmacy claim for complete review, adjudication and editing. ProPBM provides any-time access and full control over managing complex formularies, varying prescription co-pay schedules, accumulated benefits, drug utilization reviews and complex reimbursement schedules.

Real-time information for pharmacy claims processing and administration

Payers can manage all of their pharmacy benefit plans online in real-time, and ProPBM's flexible rules engine can support virtually any type of pharmacy benefit. With this control, you no longer have to wait for your vendor to implement needed changes. ProPBM lets you manage your pharmacy claims processing more efficiently and take advantage of market opportunities faster for improved financial performance.

Features of ProPBM:
  • Online 24/7 access
  • Real-time pharmacy claims adjudication and editing
  • Comprehensive decision-support
  • 99.98% PDE Acceptance Rate¹
We can help:
  • Provide information that enables design of more profitable pharmacy benefit programs, better prediction of outcomes and management of relationships
  • Promote more efficient development of pharmacy benefit management programs

¹Customer-reported ProPDE acceptance rates