Pharmacy Benefit Management Systems
IXB is dedicated to enhancing healthcare accessibility by transforming pharmacy benefit management. Our approach involves the seamless integration of all pharmacy transactions and care components to deliver a superior healthcare experience while reducing costs.
We believe that digitization, modernization, automation, and security are key factors in optimizing pharmacy benefit management systems. By digitizing processes, you gain easy access to information. Modernization brings in new technology and features to enhance the user experience. Automation of routine tasks saves time and resources. Securing sensitive data through our systems protects against potential breaches. By implementing these measures, we aim to create a more efficient and secure pharmacy benefit management system.
IXB's Pharmacy Management Systems & Solutions
IXB offers pharmacy management systems and solutions which refers to the software, tools, and technologies that are used to manage and automate various aspects of the pharmacy operations. These systems and solutions are used by pharmacies, hospital systems, and insurance companies to manage and streamline the processes of dispensing and administering medications, managing patient information, and billing and reimbursement.
Examples of pharmacy management systems and solutions include:
Pharmacy dispensing systems: These systems are used by pharmacies to manage the dispensing process, including maintaining patient information, processing prescriptions, and generating labels and other documentation.
Electronic prescribing (e-Prescribing) systems: These systems allow healthcare providers to electronically transmit prescription orders to a pharmacy, reducing the risk of errors and improving the efficiency of the prescribing process.
Medication therapy management (MTM) systems: These systems are used to manage and optimize the use of medications for individual patients, including identifying potential drug interactions and providing guidance on the appropriate use of medications.
Claims processing systems: These systems are used to process and manage pharmacy claims, including verifying insurance coverage, calculating reimbursement amounts, and generating claims reports.
Formulary management systems: These systems are used to manage the formulary, or list of covered drugs, offered by a health plan or pharmacy benefit manager (PBM) to ensure that the medications prescribed are in line with the coverage and reimbursement policies.
Specialty drug management systems: These systems are used to manage the dispensing and administration of specialty drugs, which are typically high-cost, complex drugs that require special handling or administration.
Patient portals: These systems allow patients to manage their own medication information, such as check their medication history, request prescription refills, or communicate with their healthcare provider.
Provider portals: These systems allow healthcare providers to access and manage their patients' medication-related information, such as medication lists, refill requests, and prior authorization requests.
All these systems and solutions can help pharmacies and other organizations to improve patient safety, reduce the risk of medication errors, and increase the efficiency of the healthcare delivery process.
Pharmacy Claims Processing
Pharmacy claims processing refers to the administrative process of submitting and processing claims for payment of prescription medications. The process typically begins when a patient receives a prescription from a healthcare provider, which they take to a pharmacy to be filled. The pharmacy then submits a claim to the patient's insurance company or other payer, which includes information such as the patient's identification, the cost of the medication, and the diagnosis for which the medication is being prescribed.
The insurance company or other payer will then review the claim to determine if the medication is covered under the patient's plan, and if so, how much the patient will be responsible for paying. This process may include checking for prior authorization, checking for formulary coverage, checking for dosage and quantity limits, and checking for any other coverage restriction.
If the claim is approved, the insurance company or other payer will pay the pharmacy for the medication and the patient will be responsible for any remaining cost, such as a co-pay or deductible. If the claim is denied, the pharmacy may appeal the decision or the patient may have to pay the full cost of the medication out-of-pocket.
Pharmacy claims processing is essential for patients to be able to access their medications and for pharmacies to be reimbursed for the medications they dispense.
Pharmacy Rebate Processing
Pharmacy rebate processing refers to the administrative process of submitting and receiving rebates for pharmaceutical products. Rebates are financial incentives offered by pharmaceutical manufacturers to payers such as insurance companies, pharmacy benefit managers (PBMs), and government programs in exchange for the inclusion of their products on formularies or preferred drug lists.
The process begins with the pharmaceutical manufacturer submitting a rebate agreement to the payer, outlining the terms of the rebate including the amount, the products covered and the period of the rebate. The payer and the manufacturer will then negotiate and agree on the rebate amount and the terms. After the agreement is signed, the manufacturer starts tracking and reporting the sales of the products covered by the rebate to the payer.
The payer will then process the claim and reconcile the reported sales with the agreement, and pay the manufacturer the agreed upon rebate amount. This process may take place on a regular basis, such as quarterly or annually.
Pharmacy rebate processing is a way for payers to lower their costs for the drugs they cover, by negotiating lower prices with the manufacturers in exchange for volume or market share. It is also a way for manufacturers to incentivize the use of their products over competitors' products.
Medication Therapy Management
Medication therapy management (MTM) is a set of healthcare services designed to optimize the safe and effective use of medications. MTM services may include things like medication reviews, drug regimen reviews, patient education, and coordination of care with other healthcare providers. The goal of MTM is to improve patient outcomes, such as reducing the risk of adverse drug events, improving medication adherence, and reducing overall healthcare costs. MTM services may be provided by pharmacists, physicians, or other healthcare professionals and can be offered in a variety of settings, such as retail pharmacies, clinics, or hospitals.
Pharmacy Coverage Determination
Pharmacy coverage determination refers to the process by which insurance companies or other payers decide which medications will be covered under a patient's insurance plan. This process typically involves a review of the patient's medical history and the specific medication being requested, as well as consideration of factors such as cost, clinical efficacy, and potential side effects. The outcome of the coverage determination process can affect a patient's access to needed medications and their out-of-pocket costs.
Electronic Prior Authorization
Electronic prior authorization (ePA) refers to the process of obtaining approval for a medication or treatment through an electronic system, rather than through a traditional paper-based process. This typically involves the use of electronic forms and secure messaging between healthcare providers and payers, such as insurance companies or pharmacy benefit managers (PBMs).
The process of ePA begins when a healthcare provider requests coverage for a medication or treatment and submits the necessary information, such as patient demographics and diagnosis, through an electronic system. The payer then reviews the information and makes a decision about coverage, typically based on factors such as cost, clinical efficacy, and potential side effects.
ePA can improve the prior authorization process by providing a more efficient, timely and accurate way of submitting and processing requests. Electronic prior authorization can also help to reduce administrative burden on providers, reduce the potential for errors, and improve patient access to needed medications. ePA can also provide real-time decision making and improve patient outcomes by reducing delays in starting therapy.
Pharmacy Formulary Management
Pharmacy formulary management refers to the process of creating, maintaining and updating a list of medications that are covered by an insurance plan or pharmacy benefit manager (PBM) program. This list, known as a formulary, is intended to promote the safe and effective use of medications and to manage healthcare costs by including only drugs that have been determined to be safe, effective, and cost-effective.
Formulary management involves multiple steps, such as:
Identifying and evaluating new drugs on the market
Reviewing current drugs on the formulary to ensure they continue to meet the criteria for inclusion
Reviewing and approving medication therapy management (MTM) protocols
Negotiating rebates with pharmaceutical manufacturers
Managing restrictions, such as step therapy or prior authorization requirements.
Formulary management is a way for payers to ensure that the medications covered by their plans are the most appropriate and cost-effective options for their patients, while also controlling overall healthcare costs. Formulary management can be a complex task, as it must take into account the needs and preferences of various stakeholders, including patients, healthcare providers, and pharmaceutical manufacturers.
Specialty Drug Management
A specialty drug management system is a system used to manage the utilization and cost of specialty drugs, which are a class of expensive, high-cost drugs that are used to treat complex and chronic conditions such as cancer, rheumatoid arthritis, and multiple sclerosis. Specialty drugs are typically administered by a healthcare professional and may require special handling, storage, or administration.
A specialty drug management system typically includes a number of different components, such as:
A formulary management system, which is used to create and manage a list of specialty drugs that are covered by an insurance plan or pharmacy benefit manager (PBM) program
Prior authorization and utilization management processes, which are used to ensure that specialty drugs are being prescribed and used appropriately
Specialty drug distribution and fulfillment systems, which are used to manage the distribution and delivery of specialty drugs to patients
Clinical management and support programs, which may include things like patient education and support services, as well as coordination of care with other healthcare providers.
The goal of a specialty drug management system is to ensure that patients have access to the specialty drugs they need while also controlling overall healthcare costs. By implementing a specialty drug management system, payers can help to promote the safe and appropriate use of specialty drugs, while also managing costs and improving patient outcomes.
Patient Portal
A pharmacy patient portal is an online platform that allows patients to access and manage their medication-related information. This type of portal is typically offered by pharmacies, hospital systems or insurance companies, and is accessible to patients via a web browser or mobile app.
A pharmacy patient portal typically includes features such as:
Medication lists, which allow patients to view all of the medications they have been prescribed, including dosages and frequency of use
Refill reminders and prescription refill requests, which allow patients to request refills of their medications and receive reminders when their prescriptions are due for refill
Order tracking, which allows patients to track the status of their medication orders
Medication history, which allows patients to view all of their past medication orders
Interaction with healthcare providers, which allow patients to communicate with their providers to ask questions or get information about their medications
Education and resources, which provide patients with information about their medications and how to use them safely
By providing patients with easy access to their medication information, pharmacy patient portals can help patients to be more involved in their own care and make informed decisions about their medications. It can also help to improve medication adherence and reduce the risk of medication errors.
Provider Portal
A pharmacy provider portal is an online platform that allows healthcare providers, such as physicians and nurse practitioners, to access and manage their patients' medication-related information. This type of portal is typically offered by pharmacies, hospital systems, or insurance companies and is accessible to providers via a web browser or mobile app.
A pharmacy provider portal typically includes features such as:
Medication lists, which allow providers to view all of the medications their patients have been prescribed, including dosages and frequency of use
Refill reminders and prescription refill requests, which allow providers to approve or deny requests for refills of their patients' medications
Medication history, which allows providers to view all of their patients' past medication orders
Electronic prescribing (e-Prescribing), which allows providers to electronically transmit prescription orders to a pharmacy
Prior authorization and utilization management, which allows providers to submit and check the status of prior authorization and utilization management requests for their patients
Clinical decision support, which provides providers with clinical guidelines and best practices for prescribing medications
By providing healthcare providers with easy access to their patients' medication information, pharmacy provider portals can help providers to make more informed decisions about their patients' medications, improve patient safety and reduce the risk of medication errors. It can also improve the communication between provider and pharmacy and increase the efficiency of the healthcare delivery process.
Pharmacy Issue Management Portal
A pharmacy issue management system is a system used to identify, track and resolve issues related to the dispensing and use of medications. This type of system is typically used by pharmacies, hospital systems, or insurance companies to manage the process of identifying and addressing problems that arise in the dispensing and use of medications.
A pharmacy issue management system typically includes features such as:
A reporting system, which allows individuals to report medication-related problems, such as medication errors or adverse drug events
An investigation process, which allows the pharmacy or other organization to investigate reported issues and determine the cause of the problem
A resolution process, which allows the pharmacy or other organization to implement corrective actions and prevent similar problems from occurring in the future
Tracking and monitoring of progress, which allows the pharmacy or other organization to track the progress of the issue and ensure that it is resolved in a timely manner.
By using a pharmacy issue management system, pharmacies and other organizations can identify and address issues related to the dispensing and use of medications more effectively, improve patient safety, and reduce the risk of medication errors. This type of system can also help organizations to identify and track trends in medication-related issues, which can help them to develop more effective strategies to prevent similar problems from occurring in the future.
Quality Measurement System
A pharmacy quality management system (QMS) is a system used to systematically manage and improve the quality of pharmacy services. This type of system is typically used by pharmacies, hospital systems, or insurance companies to ensure that they are providing high-quality, safe and effective pharmacy services.
A pharmacy QMS typically includes features such as:
Quality policies and procedures, which outline the organization's commitment to providing high-quality services and set out the specific steps that the organization will take to achieve this goal
Quality control and monitoring, which allows the pharmacy or other organization to measure and evaluate the quality of their services and identify areas for improvement
Root cause analysis, which allows the pharmacy or other organization to identify the underlying causes of problems or errors and implement corrective actions to prevent them from recurring in the future
Auditing and reporting, which allows the pharmacy or other organization to regularly assess their performance and report on their quality management activities
Continuous improvement, which encourages the pharmacy or other organization to regularly review and improve their processes and services to ensure that they are meeting the needs of their patients and customers.
By using a pharmacy QMS, pharmacies and other organizations can ensure that they are providing high-quality, safe and effective pharmacy services, improve patient safety and reduce the risk of medication errors. It can also help organizations to meet regulatory requirements and accreditation standards. A QMS can also help organizations to improve their performance and efficiency, and maintain a competitive edge in the marketplace.
IXB's advanced Back Office Tools & Capabilities can help unlock the full potential of your pharmacy benefit management operations by lowering costs, improving implementation speed, and enhancing quality. This can ultimately lead to increased efficiency and savings for your organization.
Software Library
IXB's source code library is a collection of reusable code modules or software components that are specifically designed for use in pharmacy-related applications or systems. These libraries can include a wide range of functionality, such as drug and formulary information, patient information, prescription processing, and claims management.
A pharmacy source code library can be used to speed up the development process of pharmacy-related software applications, by providing pre-built, tested, and debugged code modules that can be easily integrated into new systems. This can save development time and reduce costs.
Pharmacy source code libraries can include modules for:
Drug and formulary information management
Prescription processing
Claims management
Patient information management
Electronic prescribing (e-Prescribing)
Medication therapy management (MTM)
Drug utilization review (DUR)
Medication reconciliation
Pharmacy source code libraries can be used to build a wide range of applications, such as:
Electronic health records (EHR) systems
Pharmacy management systems
Prescription drug benefit management systems
Medication therapy management systems
Claims processing systems
IXB's Pharmacy source code libraries can is built using C# and Python. These libraries can also be integrated with other systems, such as electronic health records (EHRs), claims processing systems, and patient portals.
AI Decision Engine for MTM & Coverage Determination Automation
An AI decision engine for MTM & coverage determination is a type of artificial intelligence (AI) system that is designed to assist with the processes of medication therapy and prior authorization for medications.
Prior authorization is a process used by insurance companies and pharmacy benefit managers (PBMs) to determine whether a specific medication is covered by an individual's insurance plan and whether certain conditions or criteria are met. This process can be time-consuming and complex, and requires a review of the patient's medical history, diagnosis, and other relevant information.
An AI decision engine for prior authorization can be used to automate and streamline this process by analyzing data and providing recommendations on whether a medication should be approved or denied. The AI decision engine can access a patient's medical history, prescription records, and other relevant data to evaluate the request and provide an automated decision on whether the medication is covered by the individual's insurance plan.
This can help to reduce the time and effort required for prior authorization, improve the accuracy and consistency of decisions, and ensure that patients have access to the appropriate medications in a timely manner. Additionally, an AI decision engine for prior authorization can also help to identify potential drug interactions or other issues that may need to be addressed before approving a medication. It is important to note that AI decision engines for prior authorization should be used as a tool for support and not as a replacement for the final decision, which should always be made by a licensed healthcare professional.
Fax to Data Converter
A fax to data converter is a software tool that is used to convert data contained in faxes into a digital format, such as PDF, TIFF, or JPG. The digital format can then be processed and analyzed by other software systems, such as document management systems or data analytics platforms.
Fax to data converters are typically used in healthcare, finance, and legal industries, where paper-based documents, such as insurance claims, medical records, and legal documents are sent via fax and need to be converted into a digital format for further processing.
Fax to data converters typically work by receiving a fax and then converting the images contained in the fax into a digital format. The digital format can then be processed by optical character recognition (OCR) software, which can extract the text contained in the fax images and convert it into machine-readable text.
Once the text is extracted, it can be indexed and searched, and the data can be integrated into other systems, such as electronic health records (EHRs) or claims processing systems.
Fax to data converters can also be used to convert faxes into other formats, such as Excel spreadsheets or XML files, which can then be used for data analysis or data integration purposes.
Web & Integration Services Hub
A web and integration services hub is a type of software platform that provides a set of tools and services for integrating different systems and applications. It is designed to enable the communication and data exchange between different systems, applications, and services, regardless of the technology or vendor that they are built on.
A web and integration services hub typically includes the following components:
API Management: A set of tools that allow you to create, publish, and manage application programming interfaces (APIs) to connect different systems and applications.
Middleware: A layer of software that acts as a bridge between different systems and applications to facilitate the communication and data exchange between them.
Integration Platform: A set of tools and services that allow you to integrate different systems and applications, including data mapping, data transformation, and data validation.
Security: A set of security measures and controls to protect the data and systems that are being integrated.
A web and integration services hub can be used to integrate different systems and applications in a variety of ways, such as:
Data integration: to share and exchange data between different systems and applications, such as a hospital electronic health record (EHR) and a pharmacy management system.
Business process integration: to automate and streamline business processes across different systems and applications, such as a customer relationship management (CRM) system and an enterprise resource planning (ERP) system.
Application integration: to provide a seamless user experience across different systems and applications, such as a web portal and a mobile app.
Web and integration services hub can help to improve the efficiency, automation, and accuracy of different processes, as well as to provide a more seamless user experience for end-users. However, it's important to note that integrating different systems and applications can be complex, and it's important to ensure that the appropriate security measures are in place to protect data and systems.
Flat File Data Extractor
A flat file data extractor is a type of software tool that is used to extract data from flat files. A flat file is a type of file that stores data in a plain-text format, with each line of the file representing a single record and each field within that record separated by a delimiter, such as a comma or tab. Flat files are commonly used to store and transfer data between different systems and applications.
A flat file data extractor is used to extract specific data from flat files and convert it into a format that can be used by other systems and applications. The extractor reads the flat file and separates the data into fields based on the delimiter. It then maps the fields to a specific format, such as a CSV, JSON, or XML file, and exports the data.
Flat file data extractors can be used to extract data from a variety of flat file formats, including CSV, TSV, and other delimiter-separated files. They can also be used to extract data from fixed-width files, which have a predefined number of characters for each field, and from other structured text files, such as log files.
Flat file data extractors are commonly used in data integration and data migration projects, where data needs to be extracted from one system and imported into another. They can also be used to extract data from flat files that are used to store historical data, such as logs or backups, and to convert that data into a format that can be analyzed or visualized.
Data Loader
A data loader is a type of software tool that is used to load data into a database or other type of data storage system. It is used to import data from various sources, such as flat files, CSV, Excel files, or other databases, and to insert it into the target system.
Data loaders typically have the capability to:
Extract data from various sources and formats
Validate and clean the data
Transform the data to match the target system's data structure
Load the data into the target system
Data loaders can be used to load data into a variety of different types of databases, including relational databases, non-relational databases, and data warehouses. They can also be used to load data into other types of data storage systems, such as data lakes and data marts.
Data loading is an important task in data integration, data warehousing and data migration. It can also be used for data backup and recovery, and for loading test data for development and QA purposes.
Data loading is a complex process that requires a great attention to detail, as a small mistake in the data loading process can cause significant issues down the line. Data loaders include various features such as logging, error handling, and rollback mechanisms to ensure that data is loaded correctly and that any errors that occur can be easily identified and corrected.
Data File Generator
A data file generator is a type of software tool that is used to generate data files in various formats, such as CSV, JSON, or XML. The generated data files can be used for a variety of purposes, such as testing, data analysis, or data visualization.
Data file generators can be used to generate test data for software development and testing, to generate sample data for data analysis and visualization, or to generate data for use in simulations and other types of modeling. They can also be used to generate data for use in performance testing and load testing of applications and systems.
Data file generators can generate data in a variety of formats and structures, such as:
Flat files, such as CSV or TSV
JSON or XML
Excel files
SQL scripts
Other data formats
Data file generators can also be used to generate data that conforms to specific data models or data structures. They can also generate data that conforms to specific constraints, such as unique keys or referential integrity constraints.
Data file generators can be used to generate data with a specific distribution, such as normal, uniform, or skewed distributions. Some generators also allow to generate data based on specific templates or patterns.
Data file generators are often used in software development, data analysis, and testing. They can also be used in data migration, data integration, and data warehousing projects.
Why partner with IXB?
IXB offers several compelling reasons for considering a partnership, including our focus on enhancing healthcare accessibility through the optimization of the pharmacy industry, our commitment to seamlessly integrating all elements of pharmacy transactions and care, and our aim to improve the overall healthcare experience while reducing costs within the system. Additionally, we believe in the power of digitization, modernization, automation, and security to optimize pharmacy benefit management systems, leading to a more efficient and secure experience for our partners and their patients.
Our team of experts has a proven track record of delivering top-notch solutions and services to a wide range of businesses. With years of experience and industry knowledge, we understand the latest technologies and trends to deliver tailored solutions that meet your specific needs.
Our solutions are designed to be flexible and scalable, allowing your business to grow with ease. We understand the importance of cost-effectiveness and work closely with our clients to create solutions that are both efficient and cost-effective. At IXB, we're always exploring new and innovative ways to help our clients succeed, giving them a competitive edge in their industry.
When you partner with IXB, you can trust that you're working with a team that is dedicated to your success. We strive to build strong and lasting partnerships with our clients, so you can focus on what you do best. With our technology, your pharmacy can streamline operations, increase efficiency, and stay competitive in the industry. Trust in our expertise, source code libraries, and commitment to innovation to help your pharmacy digitize, modernize, and automate, reducing dependency on outdated legacy platforms.
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IXB Inc.
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100 E Pine Street
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Orlando FL