Your Medical Carrier Switched PBMs, Now What?

PBM Transition

Top 3 Things You’ll Learn

  1. Changes to expect during a transition
  2. How to take control of your situation
  3. How a trusted pharmacy partner can help

Employers in carved-out pharmacy arrangements aren’t the only ones going out to bid with pharmacy benefit managers (PBMs); health insurance carriers often do the same to weigh their options. If a carrier decides to make changes to their PBM arrangement, the consequences can be far-reaching—affecting their entire client base. If your clients are in a carved-in pharmacy arrangement with a carrier that’s making a switch, they may feel left in the dark and unsure of what to expect when this occurs. Don’t let your clients to get lost in the commotion. These tips can help you prepare them for the transition:

Carrier-PBM Transition Disruption

In any PBM transition, you will experience an adjustment period as the two entities work to build the new pharmacy benefit structure. While the carrier will try to minimize disruption for your clients and their members, the carrier is the ultimate decision makers over the terms of the arrangement, which are then passed on to carved-in employers. Your clients likely will see changes to pharmacy networks, drug formularies, specialty and mail order pharmacy dispensing, member websites, and member communications. Members will feel the impact of these changes, and they’ll need proper notice in advance and service support to address any issues or concerns.

Employers in a carved-in medical-pharmacy benefit can act now to avoid #PBM disruption and ensure their Rx plan is serving members well.

How to Protect Yourself

Rather than sit back and wait for disruption to hit, your clients can act now to ensure your pharmacy arrangement is serving their plan and their members well. To best understand their options, we recommend that you:

  • Initiate a market check
  • Compare the alternatives
  • Make changes (if warranted)

Don’t allow your clients to be forced into a new arrangement that is not in their best interest. When change is inevitable, you can rest easy knowing that there is the opportunity to make changes on your and your clients’ terms.

Evaluate the Opportunities

A trusted partner, independent from the PBMs, can help evaluate the true value of a pharmacy arrangement. By choosing a partner that provides pharmacy expertise, client-friendly contracts and tailored, transparent clinical solutions, you can achieve greater visibility into your pharmacy benefit arrangement. Having the power to choose what’s best for your company, your employees, and their dependents is a vital means to keeping your head above water.

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