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      How myPBM and myClaims simplify the pharmacy benefit management experience

      Brian Leadingham, Senior Vice President of Pharmacy Benefit Management Operations, CVS Caremark

      Briefing

      We know plan sponsors need clear, reliable information to manage pharmacy benefits with confidence and support the members who depend on them. But when claims data is spread across disconnected workflows, it can take more time to find answers and figure out how to move forward.

      Our clients told us they need a faster way to see claims details and insights. They asked for a reliable tool that could fit into existing workflows, provide real-time visibility, and help them see clearly: What happened with this claim, and what are the best next steps?

      That feedback shaped how we built myClaims, our new tool within myPBM™ that makes claims information easier to find, understand and act on.

       

      For us, innovation starts with listening. We want our enhancements to be purposeful, practical and built to support your work.

       

      Connecting information, insights and action

      Our platform, myPBM, is your one-stop shop for pharmacy benefit management.

      • Access plan information and reporting
      • Understand performance and trends
      • Efficiently manage everyday benefit tasks
      • Use integrated tools like myClaims for fast answers and understanding

      Bringing claims into focus

      myClaims puts key information into a unified experience. Instead of jumping between multiple systems and workflows, you can search, review and resolve claims using the most up-to-date data available — all in the same environment.

      myClaims has four core customizable functions:

      • Member search
      • Claim search
      • Mock claim
      • Claim override

      myClaims also has role-based access controls that simplify your view. You only have access to the information you need to do your work, so there’s less confusion and unnecessary clutter. Your CVS Caremark® team sees what you see, making it easier for us to collaborate.

      Together, these capabilities mean your team spends less time searching for information and more time reviewing recommendations for stronger decision-making.

      • Clearly understand claim status and outcomes
      • Respond to member and stakeholder questions with certainty
      • Support more efficient workflows across teams

       

      Claims support, simplified

      • One connected experience
        Research claims, review details and take action 

      • Role-based access
        See only what you need for your role — no more, no less

      • Real-time visibility
        Get the most current claims information in a click

      Integrating AI automation

       

      InsightIQ is an artificial intelligence (AI) capability built directly into myClaims. When you have a claims question, InsightIQ automatically evaluates relevant information, including your role and what you’re trying to accomplish. It then delivers insights and recommendations to help guide your decision.

       

      This gives your team one more guardrail as they evaluate appropriate, cost-effective solutions for every situation. 

       

      InsightIQ three-step process diagram with icons for claim question, content evaluation and actionable insights

      Innovating for practicality and purpose

      For us, innovation starts with listening. We build new tools and improve our existing ones based on the real challenges you face every day. We want all our enhancements to have a clear purpose, practical use and meaningful role in improving how you work.

      myClaims reflects that commitment. With your feedback, we’ll continue improving your experience, strengthening what works and shaping what comes next.

       

      Ready to see myPBM and myClaims in action?

      Request a demo