Pharmacy Benefit Manager solutions
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.
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.
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.
Analyst ReportPega is a Leader in Healthcare CRM
Find out what makes Pega a Leader in Forrester Wave™: Healthcare CRM Providers, Q1 2020.
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.
Meet your members in their moment of need
Effectively engage members for better outcomes and higher satisfaction scores with personalized interactions and care management.
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.
Enhance your existing systems
Drive innovation, reduce transformation costs, and deliver increased ROI using intelligent workflows, robotics, and AI to enhance healthcare operations.
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.
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.
Pega Process FabricConnect 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.
Pega Customer Service for Healthcare
Serve members proactively with the personalized interactions they want, on any channel.
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.
Pega Smart Claims Engine for Healthcare
Deliver modern, intelligent automation for claims management.
Eliminate cost and complexity, increase transparency and speed, and empower business and IT with low-code enterprise app development.