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We’re sharing 5 quick industry insights about pharmacy benefits.
Making a pharmacy benefit manager (PBM) transition can be a daunting task especially for busy benefit teams. We consulted our internal implementation experts on what a smooth transition looks like and how the right partner will provide reassurance that you are making the right move.
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1. What is important to a client when they transition to a new PBM?
Usually, the reason a client makes a PBM change is to increase savings and enhance service. They may also be looking for specific programs or features not offered by their previous PBM.
However, they want to transition and receive the value of the new PBM relationship with minimal disruption to their employees. They care about their employees and want a positive experience for them both at go-live (the date the new benefit starts) and throughout the relationship. They want the experience to be personalized to their company’s unique needs.
2. How much work should an implementation be for the client and their team?
Most clients, including the leaders from human resources and benefit teams, along with others engaged in making this transition, are extremely busy. Therefore, overloading them with too many meetings, choices, and to-dos is not a best practice.
A strong implementation process team recognizes this and does much of the prep work before each implementation meeting. For example, they collect information from the advisor (consultant or broker) and review the client’s data to determine their needs beforehand.
The level of effort for the client should be low. During the meetings, the client will clarify and validate the implementation team’s findings, recommendations, and documents. They will provide additional details on the current and expected benefit set-up. The client also needs to assist with designating the right attendees and coordinating schedules so the key players on their side can attend.
3. What does a seamless implementation look like for a client?
First, a seamless implementation includes:
- A series of focused meetings with agendas to guide the process with clear documentation of decisions and follow-up items
- A process which closely reviews the client’s benefit set-up and does not make any assumptions in order to avoid mistakes
- A team that can handle unique requirements and ask detailed questions
- Pre-work by the PBM before the next meeting to create efficiency and respect the client’s time
Second, the process should focus on preventing or easing member concerns and “noise” for the client which includes:
- Reviewing current drug coverage and comparing to the new formulary, then creating a plan for members
- For example, grandfathering certain drugs for a specific time period
- Bringing in financial team members to ensure billing is set-up in a timely fashion
Third, an understanding of the client’s perspective is important, including:
- A plan and resources for connecting with other vendors
- Strong collaboration with the advisor who provides guidance and expertise
- A sense of being one unified team (client, PBM, advisor) vs. separate misaligned entities
- The ability to check benefit information through an easy-to-use system to answer employees’ questions in-office rather than calling an external customer care line
- Most importantly, remembering this is the client’s pharmacy benefit and the PBM’s role is to administer it correctly
4. What makes up a strong implementation team?
Your implementation team should be responsive, organized, and communicate well throughout the process. Their commitment to a seamless experience for the employer and their employees should be evident, and their overall style should instill confidence about the change.
Some traits of an exemplary team:
- Focused on building a trusting, positive relationship from the beginning
- Sometimes this relationship starts at the finalist meeting when the implementation approach is shared, and first round introductions are made with future team members
- The role of skilled interpreter and translator
- Ability to interpret specific client details, then accurately communicate them to the rest of the PBM organization
- Translates complex PBM language into easy-to-understand language for the client
- Highly prepared and accountable
- Pre-planning so each meeting is productive and efficient
- Well-run meetings with clear agendas and note-taking, including action items
- Responds to follow-up questions promptly between meetings
- Asks for clarification to ensure correct details are captured
- A role dedicated to vendor management (medical carriers and TPAs)
Having the account team involved from the start can provide a significant advantage. When they play a key role in leading the implementation, they can get to know the client starting on day one. They learn the client’s set-up, preferences, and overall goals. Then they can serve as the main point of contact throughout the relationship to create continuity.
5. Why is collaboration with other vendors important?
Aligned to the goal of understanding the client’s perspective, it is important to understand that the pharmacy benefit is part of an overall benefit package. This package includes medical, stop-loss, and other vendors exchanging information.
Providing a holistic approach and ensuring there is connectivity between the PBM and the medical carrier and/or the third-party administrator is key. The PBM should have expansive connectivity with other carriers and work to grow and maintain these partnerships. This role may be spread across different functions or solely focused on this work.
Thank you to our experts for providing insight and industry-leading implementation services:
- Abby Kraft, Senior Manager of Client Operations
- Chris Jorgensen, Implementation Project Manager
- Krystle Burnett, Senior Implementation Project Manager
- Amy Prentice, Client Operations Vendor Manager
We welcome you to reach out to learn more about a PBM who works this way. Contact Jonathan Har-Even, VP of Sales, at jonathan.har-even@epiphanyrx.com or request a proposal by contacting sales@epiphanyrx.com or rfp@epiphanyrx.com.