Is Your PBM Meeting Your Service Expectations?

Service for a Positive Benefits Experience

Is Your PBM Meeting Your Service Expectations?

Open enrollment season is here. As much as brokers and HR benefits teams look forward to a quiet winter after the fall enrollment rush, the reality is that health benefits shouldn’t fall into the category of “set it up and enjoy autopilot for a year.”

When it comes to pharmacy plan benefits, what should you expect from your pharmacy benefits manager (PBM) throughout the year? While some PBMs tell clients to call them if there is a problem and hold a report meeting at the end of the year, there are PBMs who take a more proactive approach. As a broker or employer, look for the following services to help you and your plan members have a positive plan experience.

Regular Reports or Reviews

Regular reports or reviews with your account manager should include updates on drug spending, rebates, plan usage, the performance of clinical programs, and plan member satisfaction numbers. Taking the time to look at these items can uncover any unexpected trends that may need to be addressed before the end of the year.

Customized Reports and Analysis

Your PBM should also provide any customized reports you request. Many brokers and clients find it helpful to have benchmark reporting, comparing your plan performance to other companies of similar size. Impact analysis can also be useful when deciding on formulary options or any plan changes to understand how many members will be affected.

Read the Blog: Data Transparency: The Key to Better Plan Performance

Consultation with a Pharmacist Strategist

Clinical pharmacists should be involved in both plan design and reviews to explain the impact of formulary options, consult on trends, and offer insight into industry changes that may impact your plan, such as new biosimilars, changes to patient advocacy programs, etc.

Patient Experience Reports

Ask about quarterly data around the following metrics: number of plan members who called member services, the average call answer time (from start of call until a live person is on the line), and issue resolution data. You should also look for a PBM that actively contacts members who will be disrupted by formulary changes before the new plan year starts.

Learn More

Explore how True Rx Health Strategists can enhance your service experience by scheduling an appointment with a health strategist. Email us at

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