Report Highlights

A pharmacy switch is software that connects pharmacies to Pharmacy Benefits Managers (PBMs) and insurance companies, helping them “communicate” regarding prescription insurance claim payments.

Explore RXinsider’s latest market report, featuring a comprehensive breakdown of Pharmacy500 switch software and service providers, and get your questions answered:
– Who are the big players in the market?
– What do PBM and eVoucher workflows look like?
– What software and services are offered?

The objective of this report is to educate Pharmacy500 professionals, pharmacy leadership, and other stakeholders on key trends within the supply chain as it relates to pharmacy switch software and services.

Pharmacy Switch Workflow

1. A NEW PRESCRIPTION OR REFILL NEEDS TO BE FILLED AT A PHARMACY.
   
   
2. THE PRESCRIPTION IS ENTERED INTO THE PMS SOFTWARE (PHARMACY MANAGEMENT BY PHARMACY STAFF, ALONG WITH INSURANCE INFORMATION FROM THE PATIENT’S CARD.
   
   
3. PMS GENERATES A PRESCRIPTION CLAIM AND SENDS IT TO THE PHARMACY SWITCH.
   
   
4. THE SWITCH READS KEY INSURANCE INFORMATION, SUCH AS:
   • BIN (who to send it to)
   • PCN (how to route it)
   • Group number (which plan the patient is under)
   • Prescription details (drug, amount, prescriber, location, etc.)
   
   
5. USING THIS INFORMATION, THE SWITCH ROUTES THE CLAIM TO THE CORRECT PHARMACY BENEFIT MANAGER (PBM) OR PROCESSOR FOR PAYMENT.
   
   
6. THE PBM REVIEWS THE CLAIM TO DETERMINE:
   • If the drug is covered
   • How much the patient should pay (copay)
   • Any restrictions or requirements
   • If a prior authorization is required
   
7. THE PBM SENDS THE RESPONSE BACK TO THE SWITCH.
   
   
8. THE SWITCH ROUTES THE RESPONSE BACK TO THE CORRECT PHARMACY.
   
   
9. THE PHARMACY RECEIVES THE RESULTING PAYMENT INFORMATION.

Pharmacy500 Market Intelligence Reports

The objective of RXinsider’s weekly Market Intelligence Reports is to educate Pharmacy500 professionals, pharmacy leadership, and other stakeholders on key trends within the supply chain as it relates to the pharmacy industry.

Learn more about RXinsider’s weekly Market Intelligence Reports on our website: RXinsider.com/pharmacy_market_intelligence