Proven Outcomes

A top national PBM needed an efficient process to review pharmacy claims for discrepancies/errors prior to payment. EXL Health’s auditor expertise and IT resources developed a scalable and repeatable program across all lines of business to avoid inappropriate payments. As a result, the client:

What we do

EXL works with pharmacy leaders to deliver end-to-end services that drive efficiencies, effectiveness and quality outcomes across their business.

Pharmacy Utilization Management
Create efficiencies and accuracies across UM operations that drive cost containment and quality outcomes. Focus your pharmacy resources where needed most. [+]
Pharmacy Quality & Care Management
Leverage HEDIS, STARS and Pay for Performance (P4P) quality measures to improve patient care and to support customer’s objectives in total cost of care reduction and delivery on contractual commitments. [+]
Payment Integrity

Control costs associated with incorrectly billed or overpaid pharmacy claims, focusing on prevention, avoidance and recovery.

To learn more about EXL Health Payment Integrity offerings, click here. [+]
Pharmacy Operations and Digital Transformation
Optimize pharmacy operations and capacity support, and utilize designed, delivered and managed digital solutions based on cognitive automation, advanced analytics, AI, and other digital technologies. [+]
Population Health Insights
Prescribe actions and operationalize insights that help develop and execute benefit and program designs, enhance consumer engagement, increase intervention impactability, and measure patient outcomes. [+]
Market Growth & Expansion
Segment your market, identify and monitor trends, maximize enrollment, and prioritize opportunities and invest accordingly. [+]
How is EXL Pharmacy Services different.
Address quality care gaps
Maximizing operational efficiencies
Improve medication adherence and ensure appropriate medication utilization
Enhance clinical and financial outcomes
Who we serve

EXL services PBMs and payers (Commercial, Medicare, Medicaid health plans) that share the responsibility of ensuring high-quality patient care while minimizing costs.

Helping PBMs manage drug benefits for members with the goal of improving patient health and reduce drug spend expenditures where appropriate. [+]

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Supporting health plans’ goal of improving patient health, including appropriate and necessary drug treatment, and reducing costs. [+]

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Real Results

Digital Intelligence is the foundation of everything we do and inspires our ideas and research.

Pharmacy Services: Minimizing costs while maximizing patient care.

The primary goal shared by healthcare stakeholders is to improve the quality of patient care while reducing costs.

We deliver services that empower pharmacy leaders to focus on what matters most – addressing quality care gaps, maximizing operational efficiencies, containing costs, enabling capacity growth, improving medication adherence, and ensuring appropriate medication utilization.

US health plans partner with us
Global Clinicians
3 of the Top 5 PBMs
partner with us

Contact US