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Technology platform Built to Support a PBM Owning Its Own platform
Small to medium-sized PBMs are often limited in the services they can provide to their clients and members when they lease their adjudication engine.
Assisting a PBM in Growth Utilizing Its Own platform Adjudication.
Centric iSolutions is breaking down those limiting barriers. Centric has a feature-rich adjudication platform that they are offering at a low cost of entry. It has been adjudicating claims since 2019. In addition, this platform already includes integration with solution partners who are bringing very sophisticated industry services.
The entire solution and partners are defined later in this brochure.
How does it benefit a PBM to own its own platform?
Owning proprietary platform offers a Pharmacy Benefit Manager (PBM) significant benefits, primarily centered on:
- Control and Flexibility
- Competitive Advantage
- Operational efficiency and cost savings
- Enhanced security and data management
- Improved member and client experience
What are the drawbacks of a PBM owning its platform?
The disadvantages of a Pharmacy Benefit Manager (PBM) owning its platform are:
- High initial and ongoing costs
- Technical limitations and risks
- Vendor lock-in dependency
- Lack of transparency and potential conflicts of interest
What other challenges does a PBM face besides owning its own platform?
In addition to challenges with platform ownership, Pharmacy Benefit Managers (PBMs) face significant issues related to:
- Conflicts of interest from vertical integration
- Opaque pricing and profit models
- Increasing regulation and government scrutiny
- Rising drug costs, especially specialty drugs
- Negative public perception and client dissatisfaction
Centric iSolutions is aware of these risks and offers these risk mitigation measures
High initial and ongoing costs
- High development expenses: Centric is offering a full adjudication system for a low cost of entry, with a per-claim processing fee option.
- Maintenance and support fees: Centric does offer a maintenance fee. However, Centric also believes PBMs are better off with a long-term technology partner to manage independently in the future, such as TEKsystems and Oninit.
- Significant investment required: The product is built to cost like an off-the-shelf product but can stay customized and grow as the PBM grows.
Technical limitations and risks
- Technical debt: The technology is already developed, and many industry-standard functions and features are already built. The system offers several places to change rules, thus producing different plans that allow for custom growth.
- Lack of scalability: The underlying platform was built to handle millions of transactions. Scalability is limited to the operational aspects of the business. Even this can be managed by the solution.
- Legacy system vulnerability: The industry does not make rapid changes that obsolete the technology. NCPDP standards have been the same since 2017 and are undergoing some minor changes for 2028. With the platform’s flexibility, these types of changes will be easy to manage. If some needs arise, technology partners are ready to assist in custom changes.
- Incompatibility issues: The platform is built on a relational database, making it easy to export or import additional data with simple Extract, Transform, and Load tools.
Vendor lock-in and dependency
- Reliance on a single vendor (themselves): Technology partners with the proper knowledge can eliminate this risk.
- Impact of team turnover: Technology partners are built to manage across turnover. The system documentation and solution are managed as an asset and therefore protected as an asset.
- Limited innovation: Technology partners must stay on top of industry-leading technology. They do not become stale in their knowledge.
Lack of transparency and potential conflicts of interest
- Pricing opacity:The platform is built on transparency and requires a conscious effort on the PBM to not be transparent.
- Conflicts of interest:The PBM only owns the adjudication platform. Conflicts of interest will only arise when a PBM is large enough to have their own pharmacy network.
