How to Implement Your New PBM With Fewer Disruptions and Better Results

Carrie Brown  •   August 12, 2021

Industry-wide, pharmacy benefit implementations can be rough. With so many moving pieces in the process, it’s easy to see why. To ensure a seamless implementation, plan sponsors often turn to their broker or consultant to help them avoid any confusion and minimize disruption.

It’s a smart move. By leaning on the experts, they’ll have the support they need for a smooth pharmacy benefit manager (PBM) transition. To help maximize those results, plan sponsors should focus on the following best practices as well:

  1. Work with a trusted PBM purchasing cooperative
  2. Gather as much current plan information as possible
  3. Build-in more lead time — the more, the better
  4. Communicate early and often

A Better Way to Implement a PBM

Work With a Trusted PBM Purchasing Cooperative

Purchasing cooperatives offer ongoing support as well as many other additional benefits to self-funded plan sponsors. It’s an especially valuable service when going through a PBM implementation.

A purchasing cooperative team will start with building a foundation of customized resources and insight for a group plan’s specific situation.

Kyle Kapusta, director of sales and marketing for purchasing cooperative National CooperativeRx, explained the first steps are critical. “Offering personalized information and educating the member, the broker or consultant, and third-party administrator (TPA) through every part of the implementation keeps everyone on the same page from start to finish.”

By making plan design suggestions and recommending best practices, the member garners the most financial benefits with the least amount of member upheaval right from the start.

Jesse Dudley, implementation and clinical support manager for National CooperativeRx, noted that she recognizes change is hard for anybody, especially when so much is on the line.

“That’s where I feel like my biggest contribution is. I make sure the details are taken care of so the transition is seamless for everyone involved, most notably the plan participant.”

Jesse also included National CooperativeRx’s PBM partner, CVS Caremark, as a crucial part of a successful implementation. “They have an efficient system in place that’s very well structured and complements our style. With solid timelines and deadlines, we work together to keep all of the stakeholders on track.”

It’s clear that purchasing cooperatives and their partners provide a massive amount of assistance to member groups. They facilitate a top-notch experience and ensure that every aspect of the implementation is completed.

And because they’re known for reducing costs and adding efficiencies, plan sponsors can count on purchasing cooperatives to:

  • Focus on pharmacy benefits
  • Offer industry project management guidance
  • Provide testing, tools, and expertise as required
  • Audit for pre- and post-implementation

Of course, the real value of working with a purchasing cooperative is that they work in the best interests of the member group to help get them to the lowest net cost.

Gather as Much Information as Possible

Even with a purchasing cooperative’s assistance, a plan sponsor needs to understand all aspects of their current plan, particularly in the beginning stages of implementation, to ensure the decisions made match the intended goals of the plan sponsor.

Therefore, the time before the implementation begins should be all about gathering facts, including:

  • Copays
  • Deductibles
  • Out-of-pockets
  • Plan integration
  • Coordination of benefits
  • Drug exclusions
  • Prior authorizations

These details provide the foundation for success and ensure that plan sponsors review every nuance of their plan with their PBM. This information is necessary for making sure the implementation covers these critical components.

“We like to make sure that everyone’s on the same page from the start. We help gather all the information and talk them through each step, making sure the plan sponsor understands that the heavy lifting of the implementation experience comes at the beginning of the process.” - Kyle Kapusta, National CooperativeRx

Additional benefits of gathering current plan information include:

  1. Ability to use that data to manage costs
  2. Create an opportunity to consider different plan design options
  3. Prioritize participant impact and total savings

Self-funded plan sponsors are positioned well to have a more straightforward PBM implementation with all these considerations in place.

Make Way for More Lead Time 

Obviously, successful implementations aren’t an overnight phenomenon. They take time to plan, coordinate, and administer for the plan sponsor, PBM provider, TPA, and the PBM.

This is when using a purchasing cooperative can really be beneficial. Remember, although a good purchasing cooperative will always use an efficient approach, leaving plenty of room to go through each stage will help ease the pressure on the entire process.

When all the planning is compressed into a 45-, 60-, or 90-day timeline, everyone, including the plan’s participants, will feel squeezed. Therefore, plan sponsors will have the most manageable and successful implementations when all parties have 120 days before the new pharmacy benefits go live.

The more time everyone has, the better off you will be.

Pharmacy benefits take time to plan, coordinate, and administer for the plan sponsor, PBM provider, TPA, and the PBM.

A PBM implementation has many steps, but a plan sponsor can navigate it successfully with planning and support from a purchasing cooperative like National CooperativeRx.

Communicate Early and Often

Finally, a plan sponsor needs to ensure an open dialogue with their PBM and build an effective relationship. That means asking and getting answers about:

  • Any piece of their plan they don’t clearly understand
  • Best practices surrounding implementation activities
  • What is needed of them moving forward and what to expect

Getting fast answers and having meaningful discussions will help the plan succeed and ensure more plan participants will be satisfied with the results.

Of course, communication doesn’t end once a plan sponsor goes live with a new PBM. It’s the job of the purchasing cooperative to direct and update all parties involved with clear understandings of how the plan is running at any given time, making sure that everything is adjudicated correctly.

Plan for Implementations That Exceed Expectations

Creating a positive experience with a PBM implementation takes all hands on deck. Connecting with the right purchasing cooperative partner will produce a second set of eyes and ears leaving nothing to fall through the cracks. And most importantly, all the details will be reviewed regularly to ensure each action matches the intent.

That’s the type of support joining National CooperativeRx provides. Plan sponsors will have a guided approach that keeps this complex process as simple as possible. It’s the first step in ensuring that any PBM implementation will exceed expectations.

National CooperativeRx members may download a helpful toolkit to learn more about what to expect before, during, and after a PBM implementation. It includes information and resources that address some of the most popular implementation questions.


Self-funded plan sponsors may enroll with National CooperativeRx at any time. Contact a member of our sales team for more information on our benefits and pricing.