PBM Services

Improved Care with Smart, Integrated Solutions

inHealth’s Pharmacy Benefits Management (PBM) is a cloud-based tool that manages the processing and dispensing of drug prescriptions. inHealth’s PBM is a state-of-the-art solution that utilizes Drug Utilization Review Rules and Payer Rules to guarantee the safe consumption of drugs.

PBM aids payers in reducing pharmacy claims costs by automating the drug prescription process, which improves medical adherence and manages drug dispensing and patient use. In effect, this identifies drug fraud, waste, and abuse.

inHealth’s PBM is a smart and innovating solution that includes two sets of rules that regulate how a prescription is processed: Drug utilization review rules that detect drug-to-drug interactions, drug-disease indications, duplicate therapy prescriptions, age and gender indications, as well as information on contraindications. These rules ensure that the correct drug is prescribed, thus mitigating patient problems, provider errors, and payer costs.

As for payer rules, they include over-prescription, refill checks, real-time network member eligibility, real-time benefit eligibility, live aggregate limits, and benefit limits check. All these checks are put in place so as to eliminate fraudulent claims and drug abuse.


Generates reports periodically (daily, weekly, monthly, or quarterly).

Monitor turnaround times and analyze trends.

Perform patient safety audits, manufacturer rebate contracting, mail order pharmacy, medication management schemes and formulary management.

Review payer rules and drug utilization rules.


Upload your administrative data on OpenJet to manage pharmacy programs from your own database.

Assists in managing cost trends

Ensure medication adherence

Drug mapping enforced by the latest international standards and codes like ICD-10-CM (International Classification of Diseases), and Current Procedural Terminology (CPT).

Generate periodic reports to analyze trends and reach evidence-driven outcomes.

Perform patient safety audits, manufacturer rebate contracting, mail-order pharmacy, chronic medication management schemes, and formulary management.

Our integrated solutions are put in place to protect the healthcare industry, reducing fraud and drug abuse, and lowering administrative costs. Coupled with our e-Prescription solution, PBM saves resources that would otherwise go to avoidable patient care. By integrating both solutions, inHealth ensures that the correct, safest prescriptions are made by valid practitioners, under the right coverage.

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Explore how inHealth’s Pharmacy Benefit Solution (PBM) can simplify your pharmaceutical workflows to achieve better health outcomes.