PBM Integration

Agile Health Technologies provides complete end-to-end PBM Systems Integration in Healthcare through our integration framework, reference architecture, proven program management methodology, efficient stakeholder engagement, and structured testing. We understand the challenges of PBM implementation and utilize a successful process, tools, and techniques to help our customers in overcoming those hurdles. We go beyond the technical implementation, ensuring business needs and objectives are met. For example, adaptive pricing is a qualifying parameter for PBM. We work closely with both the business and PBM vendor to ensure the application of the right adaptive pricing rule based on enrollment. We make sure the correct LICS levels are applied by the PBM for Medicare, the right cost-sharing is used and appropriate shadow claims are processed.

PBM implementation involves appropriate stakeholder engagement and partner testing to ensure all plans from the Health Plan are mapped correctly at the PBM level, all pricing rules and benefits are applied accurately, and all rebate and healthy living programs are implemented at the PBM level as per the plan need. At Agile we bring in the perfect blend of business and technical knowledge to ensure these success factors.

PBM in Healthcare Analysis – After implementation, we analyze new PBM transactions and data to validate conformance to business objectives, modeling the path to ROI realization and any necessary corrective action plan.