For Payers

Pharmacy benefits management (PBM)


Maintain the cost-access balance, ensure positive outcomes, and foster better relationships

PBM represents an outstanding area of operational opportunity for plans

Possible returns on investment (estimated by the PCMA) can range up to $10 in cost reductions for every $1 spent.


A dedicated PBM team, according to the Pharmaceutical Care Management Association (PCMA), can lower costs for prescription drugs, manage the use of expensive specialty medications, encourage generics, and improve medication adherence and accuracy.

We believe that, to achieve the best possible results, PBM providers must be experts in building relationships, placing and tracing orders, using technology for greater efficiency, processing claims, and navigating the complex payer-provider-pharmacy-patient ecosystem.

Engaging a well-rounded partner with experience in PBM and the broader aspects of healthcare delivery and claims can lead to pass-through cost savings, better patient outcomes, and higher levels of satisfaction among all stakeholders.

Deliver on promises and contain costs despite increasing complexity

We provide around-the-clock support to combat rising medication costs. Our global team of pharmacists, pharmacy techs, nurses, and specialized agents ensures peace of mind and measurable results.

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Pharmacy claims processing

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Inbound, omnichannel customer service

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Outbound, digitally enabled communication

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Prior authorizations administration

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Medication therapy management (MTM)

Order placement and prescription refills support

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Self-service websites and virtual assistants

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Back office processing and coordination

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Formulary administration and optimization

Actively communicate with all pharma stakeholders to improve both care and value

With a sharp team of healthcare practitioners and roots in customer relationship management (CRM) and business process management (BPM), we specialize in communicating and simplifying the processes that negatively affect member, provider, pharmacy, and producer satisfaction.

With regular stakeholder interaction and an objective, 360-degree view of their activities, we uncover the most effective treatment approaches and do the double-checking that protects members and your bottom line.

By engaging a true healthcare BPM partner, ensure all of your stakeholders stay current on the latest evidence-based options, while more carefully weighing the value of generic versus branded drugs.

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Use AI and bots to improve speed, satisfaction, and savings

Digital engagement – and proactive, responsive communication – can drive drug plan improvements.

More efficiently than any human, our optimized virtual assistants (VAs) and AI-powered chatbots can answer questions and share updates about plans, deductibles, medication side effects, turnaround times, etc. quickly, at any time of day.

Add our bots to a website or mobile app, or integrate them with your contact center for escalations. Use technology to improve satisfaction and minimize costly complaints.

Digital medication therapy management (MTM) leads to +30% better results

At HGS Healthcare, our member outreach is fully digitally enabled.

With our impactability-focused member profiling technique, we accurately target those who could benefit from MTM the most.

Our clinical algorithm assigns a health coach to drive behavioral change and actionable intervention. This leads to member compliance that is +30% higher.

Combined with comprehensive medication reviews upon hospital discharge, your members are likely to experience measurably better long-term outcomes.

The need for a more active approach to PBM is growing

The CDC reports that, in the last 30 days, 49% of all US citizens have used at least one prescription drug.


Americans spend $1200 on prescription drugs per year, according to the Organization for Economic Cooperation and Development.

Keeping prescriptions affordable, appropriate, and accessible is essential.

Focused on providing maximum value for money, PBM is a demanding field of endeavor that requires increasingly active coordination, especially as the population ages.

Blue and leading national plans have relied on us for decades

We serve commercial health plans, Medicare Part D plans, retail pharmacies, and integrated healthcare systems.

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2000+ member-focused agents

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+30% member compliance

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+2M authorization requests per year

Optimize drug costs, access, and outcomes with a proven partner

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