PBM operations and technology
Intelligent Pharmacy Benefit Management and Rules Adjudication
Operational Pharmacy Benefit Management and Rules Adjudication supported by enterprise technology, from point-of-dispensing decisions to population-level cost control.
PBM operations and technology
Intelligent Pharmacy Benefit Management and Rules Adjudication
Mono Care Technologies operates as a PBM and Rules Adjudication Manager.
We combine pharmacy benefit expertise with an enterprise technology platform that evaluates prescriptions and pharmacy transactions against clinical, formulary, financial and contractual rules in real time.
Unlike retrospective claims processing, Mono Care Technologies enables intervention before a medicine is dispensed, allowing payers and healthcare providers to manage clinical risk, benefit compliance and medicine expenditure proactively.
Pharmacy Benefit Management and Rules Adjudication capabilities
Clinical decision support
Designed to surface evidence-based checks to the prescriber and pharmacist at the point of decision.
Drug utilisation review
Designed to support prospective and retrospective review of therapy against available history and configured clinical protocol.
Real-time payer adjudication
Target workflow for resolving eligibility, coverage, pricing and contractual terms in a synchronous call.
Prior authorisation
Configurable authorisation pathways designed to support automatic approval where contracted rules permit it.
Formulary management
Designed to support centralised, version-controlled drug lists, tiers and therapeutic alternatives across a configured network.
Fraud, Waste & Abuse detection
Target analytics for pattern and outlier detection across available prescriber, pharmacy, patient and medicine data.
Population analytics
Designed to support cohort, adherence and cost analytics from authorised dispensing data.