Pharmacy Benefits Management (PBM) Services

Making Medication Access Easier to Navigate

Simplifying complexity across PBM operations while reducing friction throughout the medication access journey

Transform your customer experience

Discover how Everise delivers confidence through innovative, empathetic CX solutions that drive business growth.

Challenges

Simplifying complexity across PBM operations

PBMs face growing operational complexity, volatile demand, margin pressure, and fragmented member experiences. Everise helps PBMs stabilize service delivery, scale efficiently, and maintain compliance with specialized talent and intelligent workflows.

Regulatory and Market Disruption

Federal and state reforms, including rebate transparency requirements and Medicare Part D compensation changes, are reshaping PBM operating models. These shifts increase compliance pressure, compress margins, and create confusion for members and providers, driving higher service demand and operational strain.

Fluctuating service demand

Enrollment cycles, benefit changes, and shifts in medication utilization create sharp and often unpredictable volume fluctuations across PBM operations. Fixed staffing models struggle to flex with demand, leading to delays, inconsistent service levels, and access disruptions during peak periods.

Shrinking margins

Market transparency requirements, rebate model changes, and rising medication costs are compressing PBM margins while service demands continue to grow. Without cost flexibility, PBMs face increasing pressure to sustain profitability while still meeting performance, compliance, and experience expectations.

Fragmented member experiences

Frequent changes across plans, processes, and access pathways have fragmented the member experience, creating confusion and inconsistency at critical moments of care. When access is difficult to navigate, adherence declines, support costs rise, and trust and health outcomes are put at risk.

Impact

PBM operations at scale

Everise supports leading U.S. PBMs through global, industry-trained talent and intelligent solutions, simplifying non-clinical operational complexity and delivering consistent, reliable member experiences.

Significant market presence

of the Top 5 U.S. PBMs supported

Global PBM delivery

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PBM-trained champions across 7 global locations

Trusted member experience

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Net promoter score

Approach

Seamless Prescription Journey

We support members, providers, and pharmacies throughout the prescription journey by coordinating prior authorization intake and follow-up, coverage determinations and appeals, specialty onboarding, refill coordination, and pharmacy helpdesk workflows. This reduces friction across systems and stakeholders, accelerates medication starts, and helps ensure timely, reliable access to therapy

Member & provider support

High-touch inbound and outbound support for coverage questions, prior authorization status, appeals, and access issues delivered in alignment with Medicare Part D and CMS documentation standards, maintaining audit-ready workflows while reducing provider callbacks and improving member confidence

Utilization & access support

Support across prior authorization intake and follow-up, utilization management workflows, refill coordination, and adherence outreach designed to minimize delays, prevent pharmacy abandonment, and support appropriate medication use while meeting regulatory and clinical requirements

Pharmacy & claims support

Scalable operational support for pharmacy helpdesks, claims processing, and network workflows including AEP and OEP surge capacity aligned to CMS requirements, maintaining rigorous documentation standards and audit readiness while resolving issues in real time and protecting transaction accuracy

Transform your customer experience

Discover how Everise delivers confidence through innovative, empathetic CX solutions that drive business growth.

Insights

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