Leading PBM Gets Smart With Pega BPM

Overview

Business Issue

The PBM had no formalized process for drug program creation, and patient enrollment for a new specialty drug was unnecessarily long, resource-intensive, and costly. Drug program development was manual, with each new program’s complex set of rules developed from the ground up.

Impact

Lack of coordination and automation resulted in several frustrated stakeholders. Poor initial customer experience during enrollment, sluggish new program rollout, and reporting backlogs impacted applicants and manufacturers alike and jeopardized the PBM’s specialty drug market growth goals.

Solution

Pegasystems delivered a solution spanning both program creation and patient enrollment and provided a guided process for the PBM’s program designers to rapidly build and tailor new drug programs. The new system automated the creation of questionnaires, patient registration procedures, and dozens of other protocols for each specific drug program, and it made the rules easily accessible for updates.