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Pharmacy Benefits

High Tech. High Touch. Transparent.

The PBM Opportunity

Pharmacy Benefit Managers (PBMs) play a crucial role in the healthcare system, managing prescription drug programs that directly impact patient care. Despite their importance, PBMs confront significant challenges, from complex pricing structures, outdated technology, and increasing regulations. This lack of nimbleness complicates compliance, inflates costs, and undermines trust among pharmacies, patients, and regulatory bodies. As healthcare evolves, so does the demand for PBMs to adopt transparent, efficient, and adaptive services. Many PBMs, however, remain entrenched in outdated operational models characterized by legacy systems, hindering their ability to address contemporary healthcare needs effectively.

Recognizing these systemic challenges, Aaron Greenblatt, who was at that time CEO of G&W Laboratories, launched Flipt in 2016. Flipt was conceived as a transformative response to the traditional PBM model, integrating all critical components of PBM—Benefits Administration, Formulary Development, Prior Authorization, Pharmacy Network and Contracts, Claims Adjudication, and Member/Patient Services—into the Flipt® platform, a high-tech, high-touch, cloud-native software-as-a-service solution. This new platform enabled more personalized, cost-effective healthcare solutions, significantly enhancing patient well-being and productivity. Furthermore, FLIPT infrastructure is built to adapt to regulatory changes and market dynamics swiftly, positioning it at the forefront of evolving healthcare industry requirements.

The PBM Cloud Platform

The Flipt® platform stands as a paradigm of innovation in pharmacy benefits management, designed to automate workflows and maximize operational efficiencies. Developed in the cloud with a containerized environment and modular microservice architecture, Flipt is not only scalable and flexible but also AI-enabled and ML-ready. This platform drastically enhances member experiences and optimizes all dimensions of pharmacy benefits management.

Flipt transforms pharmacy benefits management by providing comprehensive capabilities that enhance service delivery and operational efficiency. It allows for customizable drug lists and tiers, adapts to changing clinical guidelines through real-time prior authorization and step therapy, and manages drug utilization effectively with quantity limits and program edits. Pharmacy network management is optimized through strategic configurations that ensure financial and clinical effectiveness, and claims processing is enhanced with various scenarios and real-time access to claim details, promoting transparency and control. The platform’s robust architecture supports a suite of web applications essential for modern healthcare providers, ensuring seamless cross-platform integration and HIPAA compliance. Additionally, Flipt’s automated real-time transactions modernize claims and billing processes, improving efficiency and accuracy.

The PBM Transformation with Flipt

Flipt’s transformation services are meticulously designed to ensure smooth and efficient integration or enhancement of our platform, tailored to meet the unique operational needs of your Pharmacy Benefit Management (PBM). We provide comprehensive support throughout your transition and ongoing management to optimize the value and efficiency of your PBM operations.

Our services encompass platform development, where we create customized, compliant software solutions that align perfectly with your PBM’s operational needs. We specialize in system modernization to reduce technical debt and enhance system reliability, preparing your operations to be more agile and future ready. Our team ensures seamless operations through efficient integration of Flipt Platform with your existing healthcare systems, leveraging robust internal API frameworks to streamline processes and enhance system performance. Additionally, we promote scalable cloud adoption and focus on user-centric design to create intuitive digital experiences that engage users and improve accessibility. Our ongoing flexible support ensures you can effectively respond to changing market demands and maintain operational excellence.

By choosing Flipt, PBMs are empowered to transform their operations strategically, positioning themselves as leaders in a dynamically evolving healthcare environment. Our solutions are designed to meet current industry demands and anticipate future challenges, ensuring PBMs can deliver better care, improve health outcomes, and manage costs effectively. Through Flipt, you’re not just adopting new software; you’re embracing a comprehensive service and support ecosystem that propels your business forward in the complex world of healthcare.

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Our Team

Building a whole new way to offer business pharmacy benefits is a big task. We pulled together passionate, values-focused leaders who are dedicated to leading the company to its next level of growth. These are some of the brightest minds with proven track records in health benefits management, pharmaceutical development, information technology, and customer service.