Payers must have easy access to information about their pharmacy benefit programs immediately to design profitable programs, predict outcomes, and manage relationships to be able to predict outcomes, manage relationships and increase income. Unfortunately, many pharmacy benefit managers (PBMs) wait hours or even days for pharmacy benefit changes to take effect. Additionally, 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 full control of your pharmacy benefit programs

The ProPBM™ platform gives you access to any pharmacy claim for complete review, adjudication, and editing. Developed by RelayHealth’s Prospective Health Services, ProPBM lets you:

  • Design, test and implement pharmacy benefit programs for your organization
  • Access and manage:
    • Complex formularies
    • Varying prescription co-pay schedules
    • Accumulated benefits
    • Drug utilization reviews
    • Complex reimbursement schedules
     

Pharmacy claims processing and administration in real time

You’ll manage all of your pharmacy benefit plans online in real time with ProPBM. Its flexible rules engine can support virtually any type of pharmacy benefit. With this level of 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.

This pharmacy benefit management program helps you:

  • Design more profitable pharmacy benefit programs, better prediction of outcomes and management of relationships.
  • Promote more efficient development of pharmacy benefit management programs.

ProPBM features include:

  • Online 24/7 access
  • Real-time pharmacy claims adjudication and editing
  • Comprehensive decision-support
  • 99.98% PDE Acceptance Rate¹

¹Customer-reported ProPDE acceptance rates