Client had a single-sentence requirement, “We want to bring PBMs, patients, and pharmacies under the same roof – PBMs place bulk or single RX orders through Partner Portal, associated pharmacy receives those orders on its system and patients have visibility over RX status through patient portal”. But in the real world, it did not seem as easy as the client sounded – mainly financially.
Pharmacy Benefit Management software was the perfect solution to achieve the vision. But the problem was, the software must have several complex modules such as patient management, patient portal, RX ordering, prescription renewal, and CRM in order to streamline the PBM workflows.
And building such feature-heavy PBM software from scratch would cost more than $250,000 and take at least 6 months. This was not at all a rational idea to invest a pile of money in a piece of technology with a persistent fear – what if all stakeholders will not get comfortable with it? What if it does not fit the market?
So, we suggested a smart approach that would save more than $200,000 and 5 months of time in real.
Challenges & Goals
We didn’t reinvent the wheel to build Pharmacy Benefit Management software. Actually, it wasn’t required in the first place as any software is equipped with 80% of common modules and only 20% of the modules as per an organization’s use cases.
We have a powerful HIPAA-compliant base ready that we can fit into any healthcare use case by customizing it a bit as per branding needs and adding extra needed features and modules on top of the base.
For that 80% of the software, we utilized the base we already have, and for the rest 20% which actually satisfies the use case – we did code separately.
With this smart approach, we saved client from paying $100/hour as the development fee for building what we already have in our powerful base. And since we only had to fine-tune our base and code separately for those modules only which are not there in our base, we helped client to reduce time-to-market by 6 months and so did the development cost by more than $200,000.
This way, we delivered fully customized Pharmacy Benefit Management software that too in just 60 business days while saving money worth two Tesla Model S!
- PBM software must have separate dashboards for master admin (Medication Strategy Group), its partnered PBMs, patients/clients, and their POA or caregivers to perform their level of operations.
- All RX orders placed by PBMs must be automatically added to the pharmacy’s system through API.
- And order status updated by the pharmacy must be automatically reflected in PBM software through API.
- PBMs must be able to import patients from CSV files to the software.
- PBMs must have the flexibility to add patients’ physician information, current medication details, and POA details while creating the patient profile.
- PBMs must be able to place bulk RX orders.
- There must be a Document Manager to manage all important documents and set up expiry notifications to automatically receive notification on a set date before or after that document gets expired.
- There must be a comprehensive Order Management Dashboard to view all placed RX orders, status, patients for whom each order has been placed, total number of medications, and a checklist to know whether it is invoiced or not.
- PBMs must be able to do email white-labeling to send emails to their clients/patients with their own logo and their email address.
- PBMs must be able to set triggers to send and receive automatic emails and/or SMS.
- There must be a built-in chat feature for easy collaboration and communication.
- PBMs must be able to send the consent form to the patients and patients must be able to eSign it and submit it back. Additionally, there must be an expiry notification setup to make sure the patient receives an automatic notification to resign and resubmit the consent form before it expires. (It is part of the HIPAA authorization feature.)
- PBMs must be able to create internal users and give them add, view, delete, and edit permissions for each feature of the software.
- Similarly, Master Admin must also be able to create PBM accounts and give them micro levels of permissions.
- The software must be in any case HIPAA compliant.
It all started with our Business Analysts who based on the conversations with client listed all branding and custom requirements which our UI/UX Designers later designed and Developers later coded on top of our powerful base. Development team also collaborated with the pharmacy to add its API into Pharmacy Benefit Management software for cross-platform data exchange.
Our base is already HIPAA compliant and aggressively tested. So, QA Engineers tested newly added features and customized modules of the base to make sure there are no bugs, performance issues, and most importantly any newly emerged privacy vulnerabilities.
Later, when the QA team gave clearance, Network Engineers hosted the software on the server of the client and shared usage rights of the software for an unlimited number of users for a lifetime.
“Innovation does not necessarily come in the form of software every time. It many times comes in the form of designing, developing, testing, and delivering software. So, next time, be alert of companies portraying them as Innovative IT Companies!”
Technologies We Utilized
Simplicity is what we stick to. We don’t over-engineer the piece of software. We don’t choose technologies to make clients impressed with our work. Instead, we choose the technology which is actually required – even if it is a simple one.
To create an easily accessible user interface that delivers a remarkable user experience
To handle the view layer of the web app and make page reloading faster
To build a scalable and fastest backend that easily handles heavy server-side processing
To manage, store and retrieve both structured and unstructured data
To set up jobs in queue for background processing
To achieve seamless communication via SMS/email
The result is what every organization strives to achieve, cost-saving and time-saving, while not compromising the overall performance and ROI.
Completely online and optimized PBM workflows
From RX orders to prescription fulfillment and doorstep delivery of medication to patients, the entire process which involves PBMs, pharmacy and patients is now online and more optimized which leads to more affordable medications for the patients.
A complete ecosystem
Our delivered PBM software is a complete ecosystem as it brings all stakeholders under one roof by empowering each of them with their separate portals from where they can execute their levels of tasks seamlessly and receive updates on the go.
Freedom from administrative burdens
Nothing needs to be managed on paper or on spreadsheets. In fact, nothing needs to be remembered. With automatic notifications which PBMs can set and control, it becomes easy to always remain 2 steps ahead of what is called ‘non-compliance’!
Fastest, efficient, and most organized day-to-day operations
From managing the clients to placing RX orders, managing documents, and tracking order status, the average time spent on each operation is reduced by 80%. On the pharmacy side too, order fulfillment is now 3X faster, thanks to API-enabled automatic data exchange between systems.