Paving the Way to a Smoother PBM Implementation

Use the implementation process to reset, redefine and deliver on your goals.

Determining whether to switch to a new pharmacy benefits manager (PBM) partner or implement new solutions can weigh heavily on organizations.

Will my plan see additional clinical or financial value?

Will my members be satisfied with the change?

Am I confident that my team will be well supported throughout the process?

Despite these concerns, pandemic-related issues and hardships are driving plan sponsors to explore opportunities to optimize their benefits. Their aim: getting the same — or better — quality of care and service while enhancing clinical and financial value for the plan and members.  

Harnessing the power of predictive modeling and advanced analytics, PBMs can help a plan make informed decisions by fully illustrating the impact a change could have on its population — down to individual members in specific scenarios.

These insights can help plans predict possible risks or gaps, enabling them to put strategies into place for any likely scenario. In addition, when data and insights are continually monitored and assessed in real-time during the implementation, plans can have confidence that claims are processing and the changes are performing as intended.

A data-driven approach to implementation — along with a carefully managed process, a passion for delivering programs with excellence, and care and concern for a positive member experience — all make a huge difference.

Tips for a successful PBM implementation

Whether considering a change to benefits offerings or moving to a new vendor, plan sponsors can pave the way to a seamless implementation by remembering these tips:

Don’t think of implementation as a process. Consider it as strategy and an opportunity to reset, redefine and deliver your overall benefits goals.

  • Every plan and population is unique. Build on what works for you and your members and get rid of what is no longer necessary or useful.
  • Use the implementation process as an opportunity to set the strategic foundation for current and future benefits.
  • Consider changes that deliver clinical as well as financial value to the plan and to members. 

Provide complete and accurate data at the onset.

  • Insights derived from data and advanced analytics can help plans prepare for a more seamless transition and predict how members may respond to changes.

Be intentional with outreach and build a proactive engagement strategy.

  • Communicate changes as early and as often as possible.
  • Reassure, reinforce and remind members about what isn’t changing.
  • Consider options to engage and educate physicians proactively about upcoming changes.

Health is personal; outreach to your members should be too.

  • Leverage predictive analytics to understand member preferences and the best ways to reach them.
  • Evaluate a tailored approach to engaging with high-priority or high-risk members and to deliver communications through optimized and/or preferred channels.

Resources to help you plan

Every PBM implementation is different. Every plan and population is unique. Regardless of the differences, these tips apply. That said, Express Scripts understands that planning and getting started can be the hardest part of an implementation. We’re here to help. Our expertise and partnership make a difference.

Click here to learn more about PBM implementation best practices and to get a customized implementation timeline. The timeline highlights key milestones and serves as a guided resource for your plan with actions to consider during each phase of your planning process.