As frustrations mounted with their PBM, the group knew they and their members deserved much better. That’s when the decision was made to return to a trusted partner in PBD.
As a flexible, mid-sized PBM, PBD provides one-on-one servicing from the onset. With a dedicated account manager in place and a client support team established, PBD worked with the group to understand their needs and establish plan goals and priorities.
One of the first priorities was to develop a detailed and structured implementation plan to ensure a seamless transition back to PBD. The plan included an evaluation and execution of plan designs, enrollment flexibility, data exchange (claims and accumulators), quality assurance (both pre and post go-live) and developing member focused servicing to ease the transition.
While most PBMs offer various transition benefits to help ease transition disruption, PBD took additional measures to ensure a seamless transition. In addition to switching the group to PBD’s 3 tier formulary which is optimized to provide the best value at the lowest net cost, an enhanced transition benefit was put into place. This enhancement and proactive measure helped members more easily transition by working directly with the patient’s provider and providing recommended formulary alternatives to both the member and provider. The result of these measures was the perfect balance between containing Rx costs and a seamless benefit transition.
The group also expressed concerns regarding how their previous PBM charged additional fees for various enhanced plan benefits. In particular, the group expressed an interest in covering vaccine costs on behalf of their membership. Their previous PBM would only cover the cost of the drug itself, but not the cost associated with drug administration without forcing the group to pay an additional fee for this service which they treated as an add-on service.
With an inclusive drug benefit package, PBD doesn’t charge additional fees for our tremendous value-added clinical programs or clinical edits.