Pharmacy Management Services | EXL

We work with you to optimize outcomes and improve operational effectiveness

Health plans and PBMs can improve pharmacy management with our predictive and prescriptive analytics solutions, clinical quality and utilization management services, workflow technology, and prescription claim auditing capabilities.

We enhance pharmacy operations, enable digital transformation, and turn raw data into a strategic asset, providing powerful population health insights that let you stay competitive and achieve market growth and expansion.

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What we do

Evolving solutions for evolving needs

Pharmacy utilization management

Pharmacy utilization management

<p>Create efficiencies and accuracies across utilization management (UM) operations that drive cost containment and quality outcomes while enabling pharmacy resources to focus where needed most.</p>

Pharmacy quality and care management

Pharmacy quality and care management

<p>End-to-end care management services leverage HEDIS, STARS and Pay for Performance (P4P) quality measures to improve patient care and support customer's objectives in total cost of care reduction and delivery on contractual commitments.</p>

Payment services

Payment services

<p>Control costs associated with incorrectly billed or overpaid pharmacy claims, focusing on prevention, avoidance, and recovery.</p><p>Effectively conduct analytics, contract, payment policy and fraud, waste and abuse reviews to drive appropriate utilization, behaviors and accountability.</p>

Pharmacy operation and digital transformation

Pharmacy operation and digital transformation

<p>Optimize pharmacy operations and capacity support by embedding natural language processing (NLP), machine learning, conversational AI and robotics/automation into current workflows.</p>

Population & risk analytics

Population & risk analytics

<p>Driven by client data, our advanced analytics provide a comprehensive member view and deliver actionable insights into opportunities to impact member health, quality and medical costs.</p>

Market growth & expansion

Market growth & expansion

<p>Segment your market, identify and monitor trends, maximize enrollment and prioritize opportunities and invest accordingly.</p>

Insights

Explore the latest perspectives

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EXL Digital Audit Solutions

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PBM and Pharmacy client reporting

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Minimize payment disputes, increase collections and prot...

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