Modernizing Pharmacy Benefit Administration: Addressing Legacy System Friction for Health Plans

Many health plans rely on pharmacy benefit management (PBM) systems built on decades-old legacy systems. These systems create unbundled services, limited visibility, and significant workflow friction. Jessin Joseph, VP of PBA Markets at JudiHealth, explains that these older systems often require numerous disconnected integrations and lack the transparency health plans need to fully understand their own pharmacy benefits. Benefit changes tested in traditional lower test environments frequently break once pushed into production, disrupting medication access for members. A modern, cloud-based, API-driven PBA platform allows health plans to build and test benefits directly within the production environment—including date-bound and batch testing—to prevent these breaks before they occur. AI system assistance tools support clinical teams by matching faxed documentation to prior authorization requests, reducing manual administrative work while keeping clinician review at the center of final approval.