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Pharmacy Benefit Manager solutions

Transform, adapt, and engage in real time

Connect deeply and efficiently

Your reputation depends on serving your clients and their members. With Pega’s next-best-action capabilities, you can efficiently deliver personalized experiences in real time, improving engagement, adherence, and loyalty.
Improve member experience

Put your clients’ members first

Deliver truly personalized, member-centric experiences with AI-powered customer engagement – use their preferred channel, quickly provide the right information, offer the most valued program.

Explore Pega Customer Decision Hub Get the one-to-one guide
Personalize outcomes

Improve drug therapy and patient adherence

Personalized therapy and adherence programs are proven to improve outcomes and reduce costs. Use AI to improve experiences and keep members engaged – because engaged members are healthier members.

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Deepen relationships

Proactively strengthen member relationships

Become a truly trusted brand. Let Pega take your member-centricity to another level – arbitrate the right offer, at the right time, on the right channel.

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Analyst Report

Pega is a Leader in Healthcare CRM

Find out what makes Pega a Leader in Forrester Wave™: Healthcare CRM Providers, Q1 2020.

Deliver simplified experience and care

Members want healthcare simplified, yet proactive and personalized. Eliminate the confusion over prescriptions, formularies, and medication coverage. Use guided workflows and AI to quickly solve problems, answer questions, recommend the right actions, and have conversations while continuously learning and optimizing.
Simplify service

Resolve member inquiries on first contact

Whether it’s simplifying prior authorizations or personalizing medication therapy management, your clients expect you to provide a great experience. Address service needs quickly and accurately on the channel of choice using AI, guided workflows, and self-service.

Explore Pega Customer Service for Healthcare Read eBook
Close care gaps

Meet your members in their moment of need

Effectively engage members for better outcomes and higher satisfaction scores with personalized interactions and care management.

View Alere case study Explore Pega Care Management
Revitalize legacy capabilities

Serve members with speed, accuracy, and empathy

Put members first – using next best action to anticipate  needs and deliver real-time insights to drive personalized experiences. Triage service volumes by extending across digital channels, making them members for life.

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Garner operational and administrative excellence

Competition and regulatory scrutiny of Pharmacy Benefit Managers has never been more intense, which requires more efficient operations and improved performance. Use intelligent workflows to streamline, simplify, and deliver digital transformation for your operations and improved business results.
Deliver operational efficiencies

Enhance your existing systems

Drive innovation, reduce transformation costs, and deliver increased ROI using intelligent workflows, robotics, and AI to enhance healthcare operations.

View Express Scripts case study Explore Pega Platform
Enroll effortlessly

Start member experiences off right by delivering clean, fast, efficient enrollment

Crush complexity by leveraging best-in-class process automation, decisioning, and robotic automation for seamless bulk enrollment and exception handling across channels and systems.

View Healthfirst case study
Modernize billing and claims

Automate to achieve operational excellence

Billing and claims operations are the core of your business. Reduce manual touches, boost first-pass rates, and provide unprecedented administrative efficiencies by using intelligent processes and guided workflows.

Explore Pega Smart Claims Engine
   PegaWorld iNspire 2022 Replays: Catch up on keynotes, industry-specific sessions, and more. 
Make healthcare less confusing with pega healthcare payer solutions

Pega Process Fabric

Connect work with center-out business architecture

Update systems by bringing together distributed processes with flexibility and adaptability.

Proven solutions. Flawless healthcare consumer experiences.

Pega Customer Decision Hub

Get AI-powered, real-time, omni-channel engagement across the healthcare continuum – with software that anticipates what your members need next.

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Pega Customer Service for Healthcare

Serve members proactively with the personalized interactions they want, on any channel.

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Pega Care Management

Enable personalized care planning and care team coordination to drive optimal outcomes across all settings – all with AI-powered, real-time, omni-channel care management.

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Pega Smart Claims Engine for Healthcare

Deliver modern, intelligent automation for claims management.

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Intelligent Automation

Eliminate cost and complexity, increase transparency and speed, and empower business and IT with low-code enterprise app development.

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