We are redefining the future of PBMs with the launch of Better Care—a comprehensive, AI-enabled platform and programs built to meet the rapidly evolving needs of payers, providers, and members.
From Claims to Care—This is the Leap.
Building on the strength of our proven claims processing capabilities and existing clinical programs, Better Care solutions is our vision to deliver a unified, next-generation clinical platform that will blend healthcare intelligence with evidence-based programs and real-time decision-making. Our approach to AI doesn’t replace clinicians; it supports them—empowering human experts to make the final call on clinical interventions. The result: smarter, more personal, and deeply humanized healthcare experiences.
A New Model for Clinical Services.
With Better Care, Abarca introduces a clinical care suite of programs that are smart, seamlessly connected, and relentlessly focused on both the member and the provider. It’s not a reaction to industry pressures; it’s a foundation for future-focused innovation.
Lower Cost. Better Outcomes. Stronger Partnerships.
Designed to lower the total cost of care, improve clinical outcomes, and strengthen client partnerships, Better Care signals the start of Abarca’s next chapter—one defined by innovation, interoperability, and an unwavering commitment to delivering a better way in healthcare.
The PBM Landscape is Shifting
The pharmacy benefit landscape is undergoing a profound transformation. Clinical complexity is intensifying—driven by the continued rise of GLP-1s and specialty drugs—while economic pressures continue to mount. In response, payers are demanding more from their PBM partners.
It’s no longer just about cost containment; it’s about delivering smarter, faster, and more transparent and aligned approaches to managing care. At the same time, evolving regulatory frameworks, benefit redesigns, and rising patient expectations are challenging the status quo and redefining what constitutes true excellence in clinical service.
Market Trends and Challenges
Major trends are influencing the future of PBMs:
- AI and advanced analytics are driving faster, more accurate clinical decisions—from triage to targeted interventions.
- Value-based care models are reshaping incentives around outcomes, not volume.
- Specialty drug management has become the frontline of cost control, requiring precision and coordination.
- Regulatory scrutiny is forcing greater transparency and accountability with pricing and UM criteria.
- Personalized medicine and pharmacogenomics are moving from niche to norm, raising the bar for individualized care.
Our Solution: Smarter, Data-Driven Clinical Care
Too many members fall through the cracks after leaving the doctor’s office. Without real-time insights, targeted engagement, and coordinated care, nonadherence leads to ER visits, complications, and rising costs.
Better Care closes that gap.
It delivers technology-enabled, member-centered clinical programs powered by data, driven by AI, and executed by our clinical teams. While several core programs are already live, others—focused on access, affordability, and therapy management—are in active development.
Core Programs
Our Vision: Total Care, Reimagined
What Makes Better Care Different?
We building Better Care from the ground up—no patchwork, no bolt-ons. It’s more than a platform: it’s a new foundation for how PBMs can create measurable value. Here’s what sets it apart:
● It’s unified.
Programs connect into one member journey—closing care gaps and avoiding costly complications.
● It’s intelligent.
AI and data guide every step—reducing waste and driving smarter utilization.
● It’s grounded in results.
Measured by A1C, blood pressure, adherence, and fewer ER visits—proof of real savings.
● It’s practical.
Built for real lives—integrates with providers, wearables, and value-based goals to cut costs and improve outcomes.
Why Now?
Payers are feeling pressure on every front—rising specialty drug costs, complex therapies, and higher expectations for personalization, transparency, and measurable outcomes. The 2024 PBM Customer Satisfaction Report surfaces five needs that are reshaping expectations and driving demand for next-generation clinical solutions:
1. Smarter Oversight of High-Cost & Emerging Therapies. Health plans are struggling to manage the financial and clinical implications of emerging therapies—particularly GLP-1s for obesity and diabetes, biosimilars, and gene/cell therapies.
2. Enhanced Specialty Drug Management with Real-Time Patient Monitoring. With specialty spend surpassing 50% of total drug costs, payers are demanding deeper integration of pharmacy and medical data.
3. Outcomes-Based Adherence Programs, Not Just Refill Reminders. Payers are moving past legacy refill outreach models.
4. Real-Time Analytics and Transparency for Forecasting & Reporting. Plans expect their PBMs to act as data partners—not data gatekeepers.
5. Customizable, Modular Strategies Tailored to Population Health Needs. Payers are rejecting one-size-fits-all programs.
Abarca’s Promise in Action
The Better Care reflects everything we stand for:
- We Deliver Savings – With aggressive guarantees, advanced trend management programs, and a bold specialty strategy, we are lowering drug benefit costs.
- We Partner for Growth – Our technology and team were built to help payers innovate and compete in an ever-changing market.
- We Don’t Play Games – No optics, no games. We take a transparent and straightforward approach to pharmacy benefits management.
More importantly, it aligns completely with our purpose of making healthcare seamless and personalized.
What’s Next?
Abarca’s Better Care is not just a response—it’s a reinvention. Informed by client needs and the structural trends reshaping healthcare, it frames the next phase of clinical strategy: intelligent, integrated, and centered on members and providers.
At a time when other PBMs offer incremental changes, Abarca is delivering a step-function improvement in how care is identified, delivered, and optimized. Our solution combines deep clinical expertise with powerful AI-driven tools and the best partners to unify fragmented programs into a single, flexible platform designed to do more than manage—it transforms.
Better Care reflects our belief that outcomes improve when clinical insight is proactive, when decisions are data-driven, and when members are treated as individuals, not transactions. From smarter adherence and MTM workflows to next-generation specialty and access programs, this platform sets a new standard in total care—one that fully aligns with Abarca’s promise to deliver savings, partner for growth, and never play games.
About Abarca:
At Abarca, we believe in an Unstoppable Drive for a Better Way. Our commitment to making healthcare seamless and personalized for all drives us to innovate in AI, specialty pharmacy, and predictive analytics. By transforming challenges into opportunities, we deliver PBM like no one else: better patient outcomes and an overall revolutionary healthcare experience. Join us in shaping the future at the intersection of technology and care!