Scaling a healthcare PBM platform
Learn how JetRuby stabilized a complex PBM system, reduced technical debt, and enabled sustainable growth in a HIPAA-regulated environment.
Technologies
React, Ruby on Rails, Swift
Industry
Healthcare / Pharmacy benefits management (PBM)
Engagement Model
Managed delivery → Dedicated team
Platform
Web, iOS
Team
Scaled from 2 to over 40
Timeline
Ongoing partnership since 2021
Business context
The US healthcare system creates persistent friction for both employers and employees. On one side, people struggle to understand how to use their health insurance: whom to contact, which providers are covered, and how to act after receiving a diagnosis. On the other hand, prescription medications are expensive, pricing is opaque, and patients are often prescribed drugs without clear insight into more affordable alternatives.
The client built its business around addressing these challenges through two tightly connected pillars.
- The first is Medical Care Navigation, where real healthcare professionals – nurses, pharmacists, and billing specialists – respond to employee requests, guide them through care decisions, and help resolve complex insurance or billing issues.
- The second pillar is Pharmacy Benefits Management (PBM). In the US market, PBMs traditionally operate with hidden markups and complex pricing structures. The client set out to change this by optimizing prescriptions, reducing drug costs, and making pricing transparent for employers and employees alike.
Unlike most solutions on the market, these two areas were intentionally designed to work together, ensuring that medical decisions and medication choices are coordinated rather than fragmented.
When JetRuby joined
The client approached us in 2021 during a critical growth phase. Their PBM platform had been developed by a previous vendor, but mounting technical debt and scalability issues were preventing the product from supporting further expansion. At the same time, the company was preparing for a Series B funding round, making platform stability and scalability a business-critical requirement.
Without resolving these issues, both growth and funding were at risk.
JetRuby was brought in to take full ownership of the PBM domain, stabilize the existing system, and prepare it for rapid scaling.
PBM capabilities we built
At the core of the PBM platform is a set of interconnected modules designed to help members make better medication decisions while giving employers visibility and control.
Medication search & optimization
One of the primary challenges in US healthcare is that prescribed medications are often unnecessarily expensive, and patients rarely know which alternatives exist. To address this, we built a medication search and optimization engine that analyzes prescriptions against a large drug database and identifies therapeutically equivalent, lower-cost options.
Members can clearly see coverage details, pricing differences, and potential savings, reducing both confusion and out-of-pocket expenses without compromising safety.
Pharmacy selection & purchase optimization
Once an optimal medication is identified, the platform guides members through the next step — obtaining it efficiently.
After identifying an appropriate medication, the platform also helps members find where to obtain it. This includes guidance on pharmacies and purchase options, and, in some cases, the ability to initiate purchases through the member’s healthcare plan.
Benefits & spending adjustment engine
To support smarter long-term decisions, we built a benefits intelligence engine that tracks how healthcare funds are being used across individuals and families.
This module calculates benefit usage in real time, breaks spending down by category and family member, and provides a clear view of remaining coverage. As a result, members can plan healthcare expenses more proactively, while employers gain transparency into overall benefit utilization.
Coordinating medical care and pharmacy decisions
A key differentiator of the platform is the tight integration between medical care navigation and pharmacy benefits.
Missed refills, unusually high drug costs, or incomplete follow-ups are surfaced to care teams in real time. Pharmacists and medical staff can intervene early, recommend adjustments, and ensure that treatment plans and medication choices remain aligned. This coordination significantly reduces gaps in care and preventable costs.
Compliance, security & healthcare constraints
The platform operates under strict US healthcare regulations, including HIPAA and HITRUST Common Security Framework security requirements. From architecture to delivery processes, all systems were designed with compliance as a foundational constraint rather than an afterthought.
Sensitive medical data is deeply isolated, access is tightly controlled, and development workflows are structured to prevent accidental exposure. This approach ensures that operational efficiency never comes at the expense of security or regulatory compliance.
JetRuby Flow as a delivery approach
Although JetRuby Flow did not exist as a named framework when the project began, the collaboration naturally reflects its core principles.
Delivery was driven by real business outcomes rather than rigid upfront specifications. Priorities were continuously reassessed, risks were made transparent, and the focus remained on delivering the product the client actually needed to scale — not just what was initially envisioned.
This approach proved especially critical when stabilizing an inherited system under tight timelines and regulatory constraints.
AI: a measured and responsible evolution
At the outset of our collaboration, AI tools were not sufficiently robust to support the delivery process.
Over time, AI has been explored selectively as a supporting layer, primarily for internal workflow optimization, operational pattern detection, and code review. Importantly, AI is never used to replace medical professionals or compliance-critical logic, but rather to assist teams in identifying issues earlier and acting more efficiently.
Results
By stabilizing and scaling the PBM platform at a pivotal moment, JetRuby helped the client transition from vendor-related delivery risks to a sustainable, long-term growth model.
The platform successfully supported a Series B funding round, enabled rapid scaling, and continues to serve large enterprises today. What started as a stabilization project at a critical growth stage evolved into a long-term partnership supporting a healthcare platform as it scaled rapidly.
Conclusion
This case demonstrates JetRuby’s ability to take over a complex, highly regulated healthcare system at a critical moment — and transform it into a scalable, enterprise-ready platform.
By fixing what was broken, aligning delivery with real business needs, and respecting the realities of healthcare compliance, we helped create a foundation for long-term growth rather than a short-term technical fix.
