SOUTHBOROUGH, Mass.--(BUSINESS WIRE)--nirvanaHealth launches PBM-in-a-box on Amazon Web Services (AWS) to empower the adoption of Cost-Plus and 100% auditable pass-through pharmacy benefit management (PBM) models. With this platform, any pharmacy benefit administrator—including pharmacy chains wishing to enter the Cost-Plus PBM model space, state Medicaid Fee-for-Service organizations, states moving onto single PBM contracts, as well as employer groups and payers seeking a fully transparent or Cost-Plus PBM model—can offer innovative PBM solutions. Initially debuting as a full-service PBM, nirvanaHealth now opens the doors so anyone can leverage their platform to disrupt the drug benefit ecosystem.
For the past several years, organizations have been focused on redefining and disrupting the pharmacy benefit management industry. Although there has been some evolution, without the development and deployment of innovative platforms, radical disruption has yet to occur. In response to the rising healthcare spend, plan sponsors are demanding full pass-through drug pricing as well as cost and quality accountability. With pharmacy costs and pharmacy-impacted medical costs collectively accounting for nearly $1 trillion of the annual healthcare spend, the healthcare industry can no longer afford to neglect the need for rapid disruption in the pharmacy benefit sector.
PBMs have evolved to play a far more complex, multi-dimensional role in the pharmacy benefit distribution system beyond just claims processing. By acting as the hub in the prescription drug supply chain between the health insurers, pharmacies, and drug manufacturers, PBMs play a large part in drug pricing structure and prescription accessibility. PBMs develop and maintain the drug formulary and benefit design, implement adherence programs and utilization management, negotiate with drug manufacturers for rebates, and contract with pharmacies to dispense drugs to patients at the lowest cost. However, legacy PBM platforms have not evolved to efficiently handle the complexity of the PBM administrative, clinical, and financial lifecycle functions, resulting in fragmented processes and large human capital requirements. This increase in operating cost and the lack of actionable intelligence at the point-of-care and point-of-sale inevitably trickle down and lead to increased healthcare premiums.
nirvanaHealth had initially deployed the Aria PBM platform in 2016, by offering a disruptive full-service PBM solution. However, after years of proven success as a full-service PBM, CEO and Founder, Ravi Ika, says “Although we have been successful, disruption is only meaningful with a large footprint. Pass-through and Cost-Plus models are the future and we need more people to join us in redefining pharmacy benefit management.” Thus, by offering Aria PBM as a PBM-in-a-box platform solution, nirvanaHealth empowers many organizations to adopt pass-through or Cost-Plus models, accelerating drug benefit ecosystem disruption. “Healthcare disrupters,” Ika invites, “join us in the journey for drug benefit ecosystem transformation. Together, we can truly make an impact.”
The Aria PBM cloud platform leverages artificial intelligence (AI), machine learning (ML), and robotic process automation (RPA), requiring ¼ of human capital that traditional PBMs need to operate. Since pharmacy is the most frequently used healthcare benefit, the Aria PBM platform empowers real-time pharmacy care management intelligence to create cost & quality improvement opportunities at every patient touchpoint in the care continuum. With AI and ML, Aria PBM creates a 360° view of the patient and pushes actionable intelligence directly into the prescriber’s workflow and pharmacist’s workflow in real-time. The Aria PBM platform proactively monitors physician prescribing, pharmacist dispensing, and patient drug regimen patterns to influence and optimize overall healthcare outcomes. In addition, this 360° view is also presented through smart consumer-friendly apps, creating yet another opportunity to reduce cost, improve quality, and effectively engage patients in their disease-specific care management.
“Aria AI integrates clinical, demographic, utilization, and socioeconomic data to proactively map patients to predictive risk levels along multiple risk vectors, such as avoidable admissions and readmissions, ER visits, and chronic disease progression. We can then provide a custom toolkit to care providers to help reduce medical risk,” says John Sculley, nirvanaHealth Chairperson and former Apple CEO and former Pepsi-Cola Company CEO. Additionally, if desired, the Aria PBM platform can facilitate point-of-sale rebates to help reduce out-of-pocket burden and improve health outcomes. nirvanaHealth expands their product catalog to include a platform-only PBM-in-a-box solution alongside their full-service pharmacy benefit management solution and health plan-in-a-box solution.
nirvanaHealth is an innovative Payer and pharmacy benefit manager (PBM) platform provider that leverages their robotic process automation (RPA) cloud platforms to manage integrated medical, pharmacy and behavioral services that reduce overall administrative and medical costs and improve quality. nirvanaHealth offers the first cloud-native Payer and PBM integrated platform in the industry. nirvanaHealth pioneers healthcare automation by uniquely combining deep healthcare domain expertise with proven platform-building experience to deploy RPA across the Payer and PBM industries.