ProPBM: Real-Time Pharmacy Claims Processing Software

Give pharmacy benefit managers full control of their pharmacy benefit programs.

Today’s multifaceted pharmacy benefit environment is constantly evolving. Payers demand both functionality and flexibility to meet the sophisticated needs of their benefit programs, which often span multiple business lines and a host of customization based on their client’s needs.

Direct access to change and modify requirements are a must, along with quick updates and flexible configuration parameters. Long gone are the delays of waiting hours or even days for pharmacy benefit changes to take effect. Today’s software tools must include fast-action iterations to quickly move you from test to production.

Gain full control of your pharmacy benefit programs

RelayHealth’s ProPBM™ software platform leverages rules-driven pharmacy designs to deliver innovative solutions that give benefit analysts needed options for design control. For example, rule changes can be created and assigned at various levels. This flexibility delivers custom program configurations that reduce setup and on-going maintenance.

Additional ProPBM features include:

  • Real-time design, test and implementation pharmacy benefit programs
  • Access and manage capabilities for:
    • Complex prescription drug formularies
    • Varying prescription co-pay schedules
    • Accumulated pharmacy benefits
    • Drug utilization reviews (DUR)
    • Complex pharmacy reimbursement schedules

Manage pharmacy administration efficiently and effectively:

  • Manage benefit programs with ProPBM’s configurable rules engine
  • Migrate production changes based on your schedule and your needs
  • Reduce time managing benefit modifications by building and maintaining one instance, then applying needed changes to existing benefit configurations
  • Access your organization-specific data for decision support and reporting
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