Ship Formulary and Prior Auth Changes Without a Redeploy

Move formulary tiers, prior authorization criteria, step therapy, and quantity limits into a governed decision layer. Versioned, approved, and traceable, without tying every plan or formulary update to your release cycle.

Versioned Formulary Changes, Maker/Checker Approvals, Prior Auth & Step Therapy Logic, Effective-Dated Rollouts, Shadow Mode on Historical Claims, Full Audit Trails
  • Real-Time Assessment using API Connector
  • Customize Scoring Rules in No-code/low-code
  • Automated Decision-making via CRON
  • Built Complex Scoring Models in Minutes
  • Integration with Third Party Systems
  • Iterate Conditions Instantly
Pharmacy Benefit Management (PBM) Automation
Used by teams across 500+ companies globally

Built for Innovators, Trusted by Experts

At Nected, we act as partner to dervice the actual outcome and ROI and not just the solution.

100M+

Decisions executed per month

4.6/5.0

Customer rating on G2 from mid-market to enterprise customers

92%

Of Enterprise customers renew annually

10x

Faster Time to Market. Business & Tech works in truly agile manner.
PROBLEMS
80% faster turnaround on formulary and prior auth rule changes

Formulary Tiers Buried in Code

Tier placements, exclusions, and quantity limits are spread across services, so a mid-year formulary change turns into a multi-team release.

Prior Auth Criteria Living in PDFs and Heads

Clinical criteria sit in policy documents and reviewer memory. Two reviewers, same request, two different answers.

Client Variations Multiply the Branches

Every employer group wants its own copay tiers, step edits, and limits. Each exception adds another branch no one wants to touch.

Audit Requests Turn Into Archaeology

Proving which rule version decided a given claim means digging through logs and tribal knowledge instead of pulling one clean record.

Rule Changes Coupled to Release Cycles

Because benefit logic lives inside the platform, every update queues behind engineering work and deployment windows.

No Way to Prove Impact Before Go-Live

Without shadow-mode testing, a new edit goes live untested against real claim patterns. Rejections and member complaints are how you find out.

SOLUTION

Externalize the Part of PBM That's Actually Logic-Heavy

Formulary & Tiering Rule Engine

Model tier placement, exclusions, and quantity limits in decision tables, versioned, diffable, and approved before publish.

Prior Auth & Step Therapy Logic

Turn clinical criteria into explicit rules that evaluate every request the same way, with unresolved cases routed to a human reviewer along with the trace.

Plan, Copay & Pricing Rules

Handle client-specific copay tiers, plan exceptions, and pricing logic as data-driven rules instead of one more branch in the codebase.

Audit & Compliance Validation

Every rule ships with maker/checker approval, full version history, and decision traces, so an audit request takes minutes.

TESTIMONIAL

Trusted by Both Tech & Non-Tech Teams

80% Faster
Development  for our system

Nected lets us move faster than building everything in-house. With their cloud solution, URLs for staging and production are automatically set up, so we have no DevOps overhead. This speeds up development and cuts maintenance.

Greg R.
Tech Lead
SidecarHealth
2x Faster
Time to Market

Nected reduced development time by 2x and it has made our system much more modular and flexible as compared to hard-coded systems, reducing our continuous dependency on tech.

Souradeep Paul
Director of Product
Brightchamps
50% Faster
Sprint Cycle in overall

Nected’s modular rule engine and workflow system streamline complex payout calculations, achieving 3.2x faster development and cutting rollout timelines by weeks.

Ayan S.
Chief Product Officer
Wealthright
Zero
Tech Bandwidth required

Nected transformed our operations at Torch. Within hours, we integrated our systems and Google Sheets, enhancing our pricing rules workflow significantly. Nected transformed our operations at Torch.

Joe Shoop
Director Of Engineering
Torch 3PL
4x Faster
decisioning with Nected

A crucial factor for successful implementation of rules engines is when it is a customized or bespoke solution tailored for technical users, ensuring a higher level of depth, flexibility, and change tracking capabilities.

Sandeep Arora
Chief Technology Officer
Nupay
4% Growth
in conversions in 2 weeks

Nected has transformed our workflow by accelerating feature deployment by 30% and eliminating repetitive tasks. The platform's clean and intuitive interface adds to the overall experience, making it a joy to work with. We saw a 3% rise in leads and 4% growth in conversions within 20 days.

Raman Kumar
CTO & Co-Founder

Vidyakul

Ship Benefit Rule Changes With Confidence, Not Redeploys

A formulary update shouldn't need an engineering sprint. When tier placements and PA criteria live in code, every quarterly change competes with platform work, and every client exception adds one more branch to maintain. Move that logic into a rule layer and the people who own the policy can change it, while the people who audit it can actually read it.

HOW TO BUILD

Model, Test & Roll Out Benefit Rules, With Governance Built In

Model the Rule

Build formulary tiering, prior auth criteria, or step therapy logic in decision tables and rule chains. Or describe the policy in plain English and let AI Copilot draft the first version for your pharmacists to review.

Replay Against Real Claims

Run the new rule in shadow mode, or replay it over historical claims, to see exactly which tiers, copays, and approvals would change before anything goes live.

Roll Out by Plan or Client

Publish with effective dating, targeting a specific formulary, plan, or client group. No all-or-nothing release across your whole book of business.

Trace & Audit

Every decision carries its rule version and execution trace, so "why was this claim rejected?" gets answered in minutes, not a log-digging exercise.

‍

Built for Builders, Trusted by Experts

Nected isn't just another automation tool. We're the fix for rigid, outdated decision engines that slow your team down.

Joe Shoop
Director of Engineering
Spent months fighting our old rule engine. Every minor change meant bothering developers. Now we just update pricing when we need to. No bottlenecks.
James W.
Director of Product
Compliance used to be a nightmare. Our last tool barely had audit logs. With Nected we actually see who changed what. And rolling back is easy. This part often gets ignored by other tools, but here it just works.
Michael T.
Director of Engineering
Trying to scale the old setup was brutal. Expanding to new regions meant hitting API limits and random downtime. Nected handles the multi-region stuff. We launch in new markets now without the usual panic.
Olivia B.
Senior Product Manager
Constant delays and weird, inconsistent results. Used to kill our momentum entirely. Now it just processes the volume instantly.
William S.
Business Head
Lost deals because we couldn't do custom pricing fast enough. Competitors were getting ahead. Switched to Nected and that changed basically overnight. Sales finally has the flexibility they kept asking for.
Ava K.
Director of Engineering
It doesn't box you in. Hooks into whatever stack you already have via API.
Ethan D.
Business Head
Felt like we were running software from 2005 before. Clunky and slow.
Sophia L.
Senior Product Manager
You don't realize how bad your setup is until you replace it. Stuff that used to take days of manual tweaks and endless back-and-forth happens in minutes now. Dropped our error rate. System finally moves at our pace.
Free to start, and affordable as you grow!
Check Pricing Plans
FEATURES

Modern Decision Engine Built for Enterprise Scale

No Code Connectors

Seamlessly integrate with any system using simple API-based connectors. No need for complex configurations—connect databases, third-party services, and internal tools with just a few clicks.

Multiple Rule Types

Leverage a powerful rule engine with multiple rule types, including Simple Rules, Decision Tables, Decision Trees, Rule Sets, and Rule Chains to handle complex logic effortlessly.

Workflow Automation

Build any complex workflows & orchestrtation using Code, Database, and REST API Nodes, while Action nodes like Loop, Delay, and Switch Operations.

Development Lifecycle

Efficiently oversee the entire rule and workflow lifecycle with built-in versioning, git sync, rollback capabilities, and staging environments, ensuring seamless transitions from testing to production without disruptions.

Cloud-Native Deployment

Deploy Nected anywhere—choose multi-region cloud hosting for high availability or self-host on your infrastructure for complete control and compliance.

Monitoring & Reporting

Gain full visibility into your decision rules and workflows with audit trails features, and real-time dashboards. Stay compliant and track every change with ease.

White Labelled Solution

Deliver a fully white-labeled experience with embedded user functionality. Use Nected as your own branded decision engine.

Enterprise-Grade Security

Operate with confidence using enterprise-level security, role-based access control, and scalable infrastructure that ensures data integrity and performance even at scale.

AI Agents

Deploy intelligent AI Agents to automate document extraction, text classification, data enrichment, or any other domain-specific task. Build your own agents or plug in pre-trained ones directly into your workflows.

Build with AI Copilot

With our AI Copilot feature now you can build your rules and workflows with plain simple prompts or by uploading your PRD

FAQs

How is Nected different from a traditional PBM adjudication platform?

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Nected doesn't replace your adjudication engine. It takes over the part that changes most often: formulary tiering, prior auth criteria, step therapy, and plan-level rules that usually sit hardcoded in services or buried in a legacy rules module. Describe a policy in plain English or upload the PRD, and the AI Copilot drafts the rule. Your clinical and ops teams review and publish it directly, no sprint required.

Can clinical pharmacists and compliance teams build rules without engineering help?

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Yes. The visual rule builder, AI Copilot, role-based permissions, and versioned rollback mean pharmacists, benefit analysts, and compliance reviewers can author and update rules on their own. Every change is logged, timestamped, and routed through maker/checker approval before it goes live.

How does Nected handle prior authorization requests?

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Prior auth criteria become explicit decision logic: drug, diagnosis, prior therapies tried, dosage, plan. Nected's document intelligence and OCR can read faxed or scanned PA forms and pull structured fields straight into the rules, so a request is evaluated the moment it lands. Anything the rules can't decide routes to a human reviewer, with the execution trace attached.

Can we test a formulary change before it goes live?

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Yes. Run the new rule in shadow mode against live traffic or replay it over historical claims, then compare outcomes against your current logic. You see which claims would have changed tier, copay, or approval status before a single member is affected.

How fast can we go live with PBM rules on Nected?

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First rules typically go live in under 30 minutes using the AI Copilot. Full production rollouts, including connections to your adjudication platform, eligibility data, and PA intake, usually take days, not the sprint cycles a hardcoded system needs.

What systems does Nected integrate with for PBM workflows?

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Rules are exposed through REST APIs, so your adjudication platform, eligibility systems, ePA channels, and data warehouse can call them in real time. Nected also connects to databases and third-party services on the way in, so rules can pull member, plan, and drug data without a point-to-point build for every client.

How does Nected handle audit and compliance requirements for PBM?

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Every rule change, AI-drafted or hand-written, is logged with author, timestamp, diff, and approval history, with one-click rollback. Every decision carries the rule version that produced it. Nected is SOC 2 Type 2, GDPR, and ISO 27001 certified, with RBAC, encryption, and full audit exports built in.

‍

What do you mean by invocations? And how is it better than other products?

Invocations refer to the number of times your workflows/rule is triggered via API, cron or other trigger. It will count the parent rule/workflow and can have as many rules, nodes within it. This metric is often used for billing purposes. Compared to other products, invocations as a billing metric can be more cost-effective and transparent, aligning closely with your actual usage and needs. It ensures you pay for the value you receive, rather than flat rates or less relevant metrics.

What if I exceed my plan quota?

If you exceed, you'll be charged based on additional usage and will be added in your monthly charge. In case of payment failure after grace period, your plan will be reverted to free trial limiting your monthly execution and # of rules/flows as per free plan, however all your existing rules/workflow data would be kept intact.

What if I decide to cancel? Can I cancel anytime?

Firstly, we do not have a vendor lock-in, so you can cancel anytime you want. However, if you decide to cancel once your subscription for a given period has started then you would be able to cancel at the time of the next billing cycle only.

Can I upgrade my plan in between?

Yes, you can typically upgrade your Nected plan at any point during your billing cycle. The upgrade process is usually straightforward, often involving just a few clicks in your account settings. Upgrading mid-cycle may involve prorated charges for the higher-tier service.

Which plan should I go for?

The best plan depends on your specific needs, such as the expected number of invocations, the complexity of your workflows, and the level of support you require. It’s a good idea to start with a basic plan and upgrade as your needs evolve, especially if you're new to Nected. Moreover, you can also write to us at assist@nected.ai and we will help you figure out the best plan for your brand.

Would I be getting assistance in setting up Nected or building my POC?

Yes, Nected usually offers assistance in setting up and creating a Proof of Concept (POC), especially under certain plans. This assistance can include access to customer support, documentation, and possibly dedicated account management.

What level of support does the Startup and Growth plan have?

The Startup and Growth plans typically provide basic to enhanced support, including access to customer service through email or chat, a knowledge base, and possibly community forums. Response times and the extent of personalized assistance may vary between these plans.

What level of support does on-premise plan have?

The on-premise plan generally offers the most comprehensive support, including dedicated account managers, 24/7 support, and tailored assistance for deployment, maintenance, and troubleshooting. This plan is best suited for businesses with extensive, mission-critical use of Nected.

Free to start, and affordable as you grow

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