Ask the Expert: What Can My Members Expect When Changing Pharmacy Networks?

Ensuring the member experience is top of mind when making a network change.
Member Experience Awareness

Providing a good member experience is one of the top concerns Express Scripts hears from plan sponsors just before a new pharmacy network is about to launch. Employees are a company’s most valuable asset, so plan sponsors want to make sure that benefit design changes enhance that relationship.

While members’ concerns about change should always be considered, a J.P. Morgan 2019 Pharmacy Study reveals that 75 percent of plans experienced virtually no member concerns during a recent restructuring of the pharmacy networks1. However, here are a few questions to consider when a plan sponsor is evaluating their network strategy to ensure that their members are provided the best experience.

Do members have access to the pharmacies that they need, and are they using them?

Members will need pharmacy access to cover prescriptions for short-term, or acute, conditions which can be prescribed as a 30-day or less supply, as well as longer-term maintenance medications, or a 90-day supply. Having 24/7 access to pharmacies is key for member convenience, and to cover them in case of an emergency. Home delivery is also a great option to have in a network strategy, where prescriptions can come right to a member’s door. For plan sponsors, having the ability to evaluate which pharmacies are driving the highest utilization, while structuring a plan design that motivates filling prescriptions in-network can save members money, as well.

How will members be made aware of changes?

When a client decides to adjust their pharmacy network, communication is so important to ensure that the member not only has knowledge of the change, but also time to act. Prior to any network change taking place, a pharmacy benefit manager (PBM) should send several communications to the member at least 30 days in advance.  The communications should be sent using a member’s preferred channel of communication, which could consist of printed letters sent to their home, email, and outbound phone calls. Information in these materials should include a list of the new, nearby, in-network pharmacies, what medications are impacted and information on how to transfer those prescriptions. A 24/7 contact number, and an online destination like a website or mobile app are imperative to members getting all of the information they need.

Beyond the direct-to-member communication, plan sponsors should also be armed with information to share directly with employees. The PBM can provide a list of impacted members and should be able to assist in providing marketing materials for employee communications, such as email or newsletter content, posters, digital signage, and other support for Benefit Fairs or on-site needs.

What does the new pharmacy experience look like?

Once the plan sponsor makes the decision to adjust their network strategy and members are made aware of the change, the final step is transferring prescriptions. There are multiple ways this can happen: the member can ask their doctor to move the prescription, or work directly with their pharmacist. The member can also make the change online, or take a picture of the pill bottle to show their pharmacist. Access to digital tools can also help the member compare pricing at multiple in-network pharmacies to determine which is the most cost-effective and convenient for them.

Ensuring that members have a seamless experience during and after a pharmacy network change is crucial to helping them understand and maximize their pharmacy benefit. Download this checklist to keep on file if when considering changing networks and click here to learn how networks are an important strategy to a pharmacy benefit plan.


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