Technology Infrastructure for Tomorrow’s Pharmacy Benefits: Flexibility, Transparency, Access, Cost Savings and Control

As a pharmacy benefit decision-maker, ask yourself these questions: 

• Are you working with limited access to partners?
• Are you in control of when you and your team can make changes to your Plan Designs?
• Does your claims processing model allow the flexibility to integrate new partners and programs?

Across the pharmacy benefit landscape, stakeholders like yourself are rethinking their approach to technology – with demands for transparency, integrated benefit design, accurate claims adjudication and real-time data access. These capabilities define the future of PBM models and are pushing organizations throughout the healthcare ecosystem to re-examine their existing technology infrastructure.

Amid the rapidly evolving requirements of pharmacy benefits administration, now is the time for assessing current capabilities and making the move to a future-ready technology platform that meets the customized needs of each plan.  

Traditional adjudication systems, designed for fixed plan structures and post-period reporting, often fall short in today’s environment. When operational changes are needed, whether that’s adding a new client, adjusting a benefit rule or onboarding a vendor, many find themselves locked into systems that are slow to adapt and costly to maintain.

The question is no longer whether change is needed. It’s whether the underlying platform is built to support that change.

Technology That Adjusts to the Business, Not the Other Way Around

Unlike legacy PBM systems, RxLogic is designed to support ongoing change without disrupting core operations. Built on a cloud-native, SaaS-enabled architecture with a modular, API-driven design, the platform gives stakeholders the flexibility to evolve their business model without reengineering their technology from the ground up.

William Figueroa, Chief Information Technology Officer at RxLogic, explains:

“Every organization we work with has unique operational requirements. We don’t expect them to adapt to our system. We’ve designed a platform that adapts to them, securely, reliably and in real time.”

Clients can use RxLogic’s system to support fully bundled, unbundled or hybrid pharmacy benefit models. The technology infrastructure allows them to stand up new modules, rulesets or integrations while improving the member experience and provider relationships.

Modular Architecture with Strategic Configurability

The RxLogic platform is built around discrete modules that operate independently or as a coordinated system. Clients can implement core adjudication alone or integrate additional tools as needed, without vendor lock-in or platform disruption.

Core and module-support solutions include:

• Claims Adjudication Engine: configurable by plan design, network, formularies, third-party integrations and internal systems, etc.
• Rebate Administration: with claim-level tagging at the NDC 11 level and client-specific allocation logic.
• Payables and Receivables Module: supports the Payment Administration functions to your Pharmacies in the Payables and general Invoice Management to your clients in the Receivables.
• Aggregated Discount Card Solution: an agnostic SaaS platform that connects multiple discount channels through one integration, giving clients full control, transparency and freedom of choice.

Each solution is delivered through a secure, web-accessible interface, with white-label capabilities for branding and client or vendor/partner access.

Real-Time Data Access and Transparent Control

RxLogic supports full transparency and real-time operational control. Clients can access their raw claims data directly, configure reports through the UI or API and adjust pricing logic or invoicing formats in alignment with contract terms.

Billy Buckles, SVP of Product and Implementation, captures the value:

“Transparency isn’t just a reporting function. It’s a core part of operational design. From day one, our clients control how their data is used, shared and structured, because that’s how real accountability is built.”

With RxLogic, real-time financial tracking, rebate allocation and contract-specific invoice formatting are built into the system -- no external tools or manual reconciliation required.

A Case for Flexibility: Transitioning from Legacy Systems

Regional PBMs managing multiple lines of business, including hospice, employer carve-outs and specialty programs, often face limitations with legacy platforms. These systems can make it difficult to onboard new clients with different benefit designs, support real-time prior authorization and integrate rebate allocation across multiple rebate partners.

With RxLogic’s modular structure, PBMs can:

• Stand up adjudication and payment modules to support go-live, moving as fast as the client is ready, with timing dependent on program type.
• Flexible implementation aligns with client’s pace and compliance timelines.
• Configure plan-specific rules and pricing logic directly through the UI.
• Integrate external rebate and reporting tools via the API suite.
• White-labeled portals allowing seamless employer and broker access.

These improvements obviate the need for replacements to the core infrastructure or the introduction of third-party middleware, allowing PBMs to maintain operations while expanding offerings and meeting reporting requirements with system-native tools.

Automation Without Custom Code

Many benefit administrators are constrained by systems that treat every exception as a manual process. RxLogic takes a different approach: Smart automation is embedded into every layer of the platform, allowing for faster workflows without sacrificing oversight.

Support Tools include:

• Real-time claim edits and adjudication decisioning.
• Copay assistance integration.
• Configurable plan adjustment workflows with audit tracking.

These tools reduce time to resolution, improve consistency across lines of business and provide a direct path to scaling services without expanding administrative teams.

Serving a Diverse Benefit Ecosystem

RxLogic’s future-ready platform is structured to support a wide variety of stakeholders, including:

• Pharmacy Benefit Managers (PBMs)
• Health systems (IDNs) and retail chains
• Third-party administrators (TPAs)
• Self-insured employers and payer coalitions
• Hospice and long-term care PBMs
• Workers’ compensation and specialty carve-outs
• Pet and veterinary pharmacy benefit platforms

Each deployment is configured to reflect the client’s plan structure, operational model and integration needs. Nothing is hard-coded. Nothing is locked in.

Meeting What Comes Next

The pharmacy benefit marketplace continues to evolve, driven by regulation, pricing dynamics and shifting expectations from plan sponsors and members alike. Organizations that cannot adapt to these growing demands will be at a disadvantage.

RxLogic was built with that trajectory in mind.

Its cloud-native, modular platform provides the infrastructure to evolve operations, improve transparency and deliver scalable performance without disruption. From configurable adjudication to integrated payment management and real-time reporting, RxLogic enables pharmacy benefit stakeholders to modernize without compromise.

Figueroa adds:

“Technology should allow you to respond to what’s happening in your business—not hold you back from acting on it. That’s the kind of system we’ve built.”