HR leaders may fear pharmacy benefit disruption will take their employees out of their comfort zone and create more headaches than growth opportunities. But in reality, members experience disruption regularly, and with an expert member and plan advocate on your side, you can minimize friction when making a benefits change.

Minimal Disruption Can Maximize Savings

PBMs change formularies regularly – often, multiple times per year. Members may need to switch to an equally effective alternative medication based on these changes, which shows employees can handle changes when they need to.

Basic utilization management techniques like prior authorizations and step therapy protect member health and plan sponsors’ dollars and ensure the pharmacy plan meets the business’s expectations.

On average, only 2% of members use the most expensive specialty drugs and need the most care and attention. They drive 50% of pharmacy plan costs. A deep knowledge of members, specialty
medication trends, and the changes that will impact costs while minimizing unnecessary disruption is needed to create successful UM programs.