April 4, 2024

Banjo Health: Driving PBM Growth through Innovation in Prior Authorization

In the competitive landscape of Pharmacy Benefit Managers (PBMs), standing out requires more than just delivering core services. It demands innovation, efficiency, and a keen understanding of the client's unique needs. Banjo Health has emerged as a pivotal partner for PBMs aiming to differentiate themselves in this space. Our case study of a large PBM client competing for a significant Health Plan contract illustrates how Banjo Health's technology solutions can be a game-changer in winning new business.

The Challenge

A leading PBM was in the runningfor a lucrative contract with a large Health Plan in the Midwest, which servesover 300,000 lives across Commercial, Exchange, and Medicare lines of business.With the Health Plan evaluating its options among the Big 3 PBMs, the challengewas clear: how to distinguish their offeringin a market where most core PBM services are comparable.

Banjo Health's Solution

Banjo Health stepped in with its innovative platforms, BanjoPA and Composer, which were showcased during the client's finalist presentation for the RFP. These platforms offered unique advantages:

  • BanjoPA Platform: Leveraging AI and built-in automations, this platform simplifies the prior authorization process, offering an intuitive user interface that sets it apart from competitors.
  • Composer Platform: This platform provides the flexibility for health plans to manage their clinical criteria within the PBM's workflow, offering unprecedented control and adaptability in the prior authorization process

The Outcome

Our client's approach, bolstered by Banjo Health's platforms, was a decisive factor in their selection over the incumbent and other top competitors.The Health Plan recognized the distinctive approach to prior authorization offered by our client, citing the BanjoPA and Composer platforms as significant factors in their decision. Our technology enabled our client to differentiate themselves by enhancing operational efficiency and offering a more adaptable and user-friendly PA process.


The success of our client in this competitive RFP underscores the critical role of innovative technology in the PBM industry. Banjo Health's solutions not only enhance operational efficiency but also enable PBMs to offer a more adaptable and user-friendly process. By focusing on innovation and client-specific needs, Banjo Health empowers PBMs to differentiate themselves and secure new business in a crowded marketplace.