Cognizant Business Consulting
Helping organizations engage people and uncover insight from data to shape the products, services and experiences they offer
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  • Working to reshape business models, modernize products and enhance customer experiences to drive growth.
  • Reinventing and managing your most essential business processes with new ways of working.
  • Simplifying, modernizing and securing the IT infrastructure and applications that are the backbone of your business.
Cognizant Business Consulting
Helping organizations engage people and uncover insight from data to shape the products, services and experiences they offer
Learn More

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Prepare for the future: Revitalize revenue streams, optimize key business processes and improve operational health systems today.

Pharmacies and PBMs face a myriad of changes that are driving reinvention of business operating models—regulatory and demographic changes, consumerism, technological advances, shrinking margins in core revenue streams and commoditization of services. The best way to deal with these changes is by being able to rapidly build distinctive capabilities and optimize existing operations.

Cognizant helps retail, specialty and mail order pharmacies and PBMs understand the impact from fast-paced industry developments and rapidly respond to changing market dynamics.

CAPABILITIES

Regulatory Compliance

Cognizant helps healthcare organizations evaluate the impact of regulatory requirements and implement supporting solutions to help ensure compliance.

  • ICD-10
  • Medicare Part D compliance
  • NCPDP D.0 compliance
  • Controlled substance dispensing
  • Patient compliance

Health Intelligence and Analytics

The ability to access and leverage data is changing the way business decisions are made, with rich insights enabling evidence-based decision-making and proactive planning. Cognizant provides expertise on the data that should be collected across a wide range of attributes affecting pharmacy and PBM businesses, helping you make well‑informed decisions.

  • Analytics strategy
  • Process innovations

Investigative Services

Enabling organizations to identify and resolve intentional and unintentional errors or verify the absence of both is critical. With significant dollars being lost to fraud and abuse each year, investigation and recovery efforts are critical to an organization’s overall financial health.

Operational Improvement

We help healthcare organizations drive cost reduction and revenue enhancement through improved efficiency and effectiveness and process transformation.

  • Best-in-class series (Claims, Enrollment, Medical Management)
  • Requirements
  • Product evaluation and selection
  • Operational readiness (BPS)

Consumerism

New consumer-focused operating models in healthcare demand a shift in thinking, requiring many companies to go from a B2B to B2C focus. Cognizant helps healthcare organizations understand the requirements for health benefit exchanges, manage the patient and member experience with solutions that drive engagement and help build effective strategies for member identification and retention. Our services span these areas:

  • Customer engagement
  • Customer experience
  • Customer retention

Implementation Services

We offer complete project and IT implementation and support services, including:

  • Legacy systems modernization
  • Administrative, claims management, clinical and electronic health record implementations
  • Custom development and maintenance
  • Systems integration and program management
  • ERP and CRM systems
  • Data warehouses
  • E-health, self-service applications and portal development

RESOURCES

Future-Proofing the PBM and Pharmacy Business

Pharmacies and pharmacy benefit management firms (PBMs), large and small, are being forced to fundamentally remake their business models. By embracing new and distinctive organizational designs that make pharmacies and the PBM more agile, pharmacy and PBMs can optimize key business processes and improve their overall operational health.

PBM Compliance with Medicare Part D

Background on the role and reporting requirements of PBMs participating in Medicare Part D, regulatory mandates and audits and steps to ensure full compliance and survive federal scrutiny.

Pharmacy Benefit Management | Cognizant Technology Solutions