NanoPBM

NanoPBM, known as Nano Pharmacy Benefit Management, is a digital health solution designed to streamline and optimize pharmacy benefit management processes. According to the vendor, NanoPBM helps healthcare providers, payers, and companies manage and administer prescription drug benefits for their members or employees. It is suitable for businesses of various sizes, ranging from small clinics to large healthcare organizations and insurance companies. NanoPBM is utilized by healthcare providers such as hospitals, clinics, and pharmacies, as well as insurance companies, companies managing employee benefits, pharmaceutical companies, and managed care organizations.

Key Features

Prescription Benefit Management: According to the vendor, NanoPBM efficiently manages and administers prescription drug benefits for patients, members, or employees. It allows tracking and monitoring of prescription drug usage, including medication adherence and refill reminders. The system also streamlines prior authorization processes to ensure timely access to necessary medications.

Claims Processing: NanoPBM automates and streamlines the processing of prescription drug claims, according to the vendor. It verifies eligibility and coverage for prescription medications and accurately adjudicates claims, reducing errors and minimizing claim rejections. Detailed reports on claims processing, including claim status and payment information, can be generated.

Pharmacy Network Management: The vendor states that NanoPBM helps maintain and manage a network of pharmacies for prescription drug dispensing. It facilitates the establishment and maintenance of contracts with pharmacies, ensuring compliance and quality standards. The system also monitors pharmacy performance and tracks prescription fulfillment metrics, while enabling seamless communication between healthcare providers and pharmacies.

Medication Therapy Management: NanoPBM provides comprehensive medication therapy management services, according to the vendor. It conducts medication reviews and assessments to optimize patient medication regimens and identifies and resolves medication-related issues, including drug interactions and potential adverse effects. The system also educates patients on proper medication use, adherence, and potential side effects.

Formulary Development and Management: According to the vendor, NanoPBM helps develop and manage drug formularies tailored to specific healthcare plans or organizations. It regularly updates formularies based on clinical guidelines and evidence-based medicine. The system implements cost-effective strategies, such as tiered formularies and generic substitution programs, and provides tools for healthcare providers to access formulary information and make informed prescribing decisions.

Drug Utilization Review: NanoPBM conducts comprehensive drug utilization reviews to ensure appropriate and safe medication use, according to the vendor. It analyzes prescription drug data to identify potential drug interactions, duplications, or contraindications. The system generates alerts and recommendations for healthcare providers to optimize medication therapy, aiming to improve patient safety and reduce the risk of adverse drug events.

Reporting and Analytics: NanoPBM generates customizable reports on prescription drug utilization, costs, and trends, according to the vendor. It analyzes data to identify patterns and insights for better decision-making. The system also monitors key performance indicators related to prescription drug benefits management, facilitating data-driven strategies for improving patient outcomes and cost-effectiveness.

Integration and Interoperability: According to the vendor, NanoPBM seamlessly integrates with existing healthcare systems, such as electronic health records (EHRs) and pharmacy management systems. It enables secure data exchange and interoperability between different healthcare stakeholders, improving communication and coordination between healthcare providers, payers, and pharmacies. The system aims to enhance data accuracy and reduce manual data entry through automated data exchange.

Compliance and Regulatory Support: NanoPBM ensures compliance with regulatory requirements and industry standards, such as HIPAA and CMS guidelines, according to the vendor. It facilitates adherence to formulary management regulations and drug utilization review policies. The system generates audit trails and documentation for regulatory reporting and compliance purposes, while staying updated with evolving regulatory changes and adapting accordingly.

User Management and Access Control: NanoPBM allows the management of user roles and permissions to ensure appropriate access to system functionalities and data, according to the vendor. It implements secure authentication and authorization mechanisms to protect sensitive information. The system tracks user activities and maintains an audit trail for accountability and security purposes. The vendor also provides training and support for system users to maximize utilization and efficiency.