3 Smart Steps When Switching Pharmacy Benefit Management Companies

Decrease Disruption for Employees and Your Team

Selecting a new pharmacy benefits management company is never an easy task, and human resources managers and executives often dread the headaches that might come with a change. However, there are several smart steps employers can take early in the transition process to help decrease disruption and smooth the transition to a new pharmacy benefits plan. 

If you are an HR professional, CFO, health insurance broker, or TPA, be sure to take these three steps as part of the transition to a new pharmacy benefits management company (PBM).

Get Employer Leadership Engagement 

Be sure company leaders are focused on more than just saving money when switching PBMs. Leaders need to understand the implementation process and timeline. 

They should also consider the scope of impact formulary changes may create for employees. If many employees are affected, leaders should ask their broker or PBM questions about a phased approach to formulary changes or if it is possible to still meet financial goals while also making some changes to the proposed formulary. 

Plan Proactively for Formulary Changes 

While some companies may put off switching PBMs due to the potential disruption caused by formulary changes, remember that it is likely your existing plan will also implement formulary changes. 

The first thing I would tell people is that your formulary will change, even if you stay with your current PBM,” says Aaron Searls, RPh, MBA, Vice President of Business Development, True Rx Health Strategists. The formulary is not a stagnant document. It is a living, breathing, ever-changing list. Tiering changes, preferred options, and other formulary factors are always in motion with any PBM.” 

Consider these strategies for minimizing disruptions due to formulary changes when you start with a new PBM: 

  • Consider open” or less restrictive formularies if/​when data is limited prior to a transition or when groups are extremely sensitive to benefits changes 
  • Create prior use exceptions for a limited time. 
  • Develop a communications plan for employees who will be impacted by formulary changes or those who have complex or chronic conditions. Early, proactive outreach can help members arrange a prescription for an effective alternative medication or secure prior authorization. 

Build an Ample Runway for Implementation 

If your organization can allow 90 days from signing a contract to the plan go live date, it significantly increases the chances of a smooth transition. At the very least, you need a 60-day window for implementation steps. Other keys to help create a worry-free implementation include: 

  • Provide eligibility files to your new PBM as soon as possible. Successful file integration is crucial to a new plan starting on time. 
  • If you are working with a broker or third-party administrator, be sure they are working as a team with the new PBM. 
  • Build clear and thorough communication with employees during and after open enrollment.

The best laid plans can still have issues, but when you have time, effort, and champions to lead a PBM transition, it means the process has a much higher chance for success,” says Searls. 

Learn More PBM Transition Tips in Our Webinar 

Explore more strategies in our recorded webinar, Proven Strategies to Decrease Disruption When Switching PBMs. Guest panelists Sue Seitz, Dan Myers, and Michael Andrade join Aaron Searls, RPh, MBA, in this discussion.