Client
The Issue
- Formulary Management Complexity – Ensuring medications are cost-effective, clinically appropriate, and compliant with industry regulations was a daunting task.
- Inefficient Pharmacy Utilization Management – Processes like prior authorizations, appeals, and drug utilization reviews were time-consuming, leading to delays in patient care.
- Fragmented Technology Ecosystem – PBMs and health plans lacked a unified digital platform to manage benefits seamlessly while accessing a curated selection of service providers.
- Tracking and Compliance Issues – Monitoring complaints, drug utilization, and member satisfaction required an intelligent and automated approach to ensure compliance and optimize outcomes.
- Need for Market Innovation – FutureRx wanted to empower health plans and PBMs, giving them more control over pharmacy benefits while leveraging cutting-edge technology.
The Solution
Ziel Global partnered with FutureRx to build a powerful, AI-driven mobile app that addressed these challenges head-on. The app was designed to optimize pharmacy benefits, enhance regulatory compliance, and improve patient outcomes through advanced automation and analytics.
Key solutions implemented included:
Dynamic Formulary Management – A centralized system that automatically updates drug lists, ensuring cost-effective and clinically sound medication selections.
Automated Pharmacy Utilization Management – AI-driven workflows for prior authorizations, appeals, and drug utilization reviews, significantly reducing manual work and delays.
Integrated Healthcare Ecosystem – A collaborative digital space where PBMs and health plans could connect with verified technology and service providers, improving operational efficiency.
Data-Driven Decision Making – Advanced AI and analytics tools helped PBMs and health plans make real-time, informed decisions about medication management and utilization.
Enhanced Member Experience – A user-friendly interface that allowed members to track their prescriptions, receive personalized medication management tips, and access real-time pharmacy support.
The Outcome
Regulatory compliance improved, with real-time updates ensuring that all formulary and utilization management processes met industry standards.
Processing times for prior authorizations and appeals were reduced by 60%, streamlining patient access to necessary medications.
Data-driven formulary decisions resulted in improved cost savings and better clinical outcomes for patients.
- PBMs and health plans regained control over pharmacy benefits, accessing a unified platform to manage their services efficiently.
User adoption rates soared, with members appreciating the app’s personalized medication management tools and seamless experience.
