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 arrangement, the consequences can be far-reaching—affecting their entire client base. If you’re an employer in a carved-in arrangement with a carrier that’s making a switch, you may feel left in the dark and unsure of what to expect when changes occur. We don’t want you to get lost in the commotion, and these tips can help prepare you 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 benefit structure. While the carrier will try to minimize disruption for clients and members, they are the ultimate decision makers over the terms of the arrangement, which are then passed on to clients. You likely 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, you can act now to ensure your pharmacy arrangement is serving you and your members well. To best understand your options, we recommend that you:

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

Don’t be forced into a new arrangement. When change is inevitable, you can rest easy knowing that there is the opportunity to make changes on your 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.

Related: See our post on the advantages of carving-out the pharmacy benefit.

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