Navigating PBM Transitions: A Q&A with HR Expert, Rena Cater

Most HR professionals likely didn’t choose their profession because they love insurance paperwork and complex plan decision-making, and yet, those things can end up taking up most of their time and brain power. Pharmacy benefits, which now account for huge line items in HR’s budgets, have spiraled out of control due to the self-serving nature of legacy Pharmacy Benefits Managers (PBMs). 

HR teams are feeling the sting of legacy PBM’s poor practices and know they need a different approach—but where do you start? Learn from HR trailblazers, like SmithRx client Rena Carter, VP of Human Resources at Eagle Transport Corp, who have successfully navigated PBM transitions. Getting to the heart of what your business requires for pharmacy benefits, and what you need in a pharmacy benefits partner, starts with asking the right questions of your current and any future PBM.

Read on for a recap of our recent session with Rena at Millennium Alliance NOLA 2025 where she covered how her team took control of their pharmacy spend by questioning the status quo and prioritizing transparency in their partnerships.

Recognizing the Need for PBM Change

Question: What are the tell-tale signs that it's time to re-evaluate your PBM?

Answer: While each business is going to have unique needs and a different relationship with their pharmacy benefits vendor, there are some class indicators that it may be time to look for a new, more modern PBM. 

Firstly, if you’re getting inundated with complaints from your members, or employees, that could be a red flag. This can span across a whole different number of areas such as high co-pays, issues with filling prescriptions, and a lack of access to medications they need to stay healthy. If there’s anything fundamentally wrong with your current PBM, your members’ experience will be affected. 

On the other hand, if you’re seeing complaints around high co-pays from members, it’s likely your plan costs are growing too. If you see that your pharmacy spend on the whole is consistently increasing without a clear reason, you should consider other options. With legacy PBMs, you may notice that they guarantee a certain discount, but your plan spend still goes up. A general lack of transparency in this regard, coupled with mis-alignment to your fiduciary duty are major signs that they’re not the right partner for you.

Question: How do you initiate the internal conversations to begin the PBM evaluation process?

Answer: It’s incredibly important to have your leadership team involved and bought into the transition. This includes your CEO and well as any leaders from your finance department like your CFO, as they have a vested interest in making sure your HR spend is as effective as possible.

If you’re working with a broker, it’s important that you advocate for exploration of all options: not just legacy PBMs. That may involve speaking up to get more modern benefits partners, like SmithRx, included in the evaluation process and doing your own research to some degree. Many brokers may feel uncomfortable with separating pharmacy benefits from an organization's TPA, but in my experience, that move was essential. 

Transparency needs to be a priority from day dot. Make sure you’re getting data around what your plan currently pays and each of your benefits partners pay. This information will help fuel conversations with other stakeholders and lead your team to the essential questions you should be asking currency and future partners about the real financial impact they can deliver. 

Navigating the PBM Evaluation Process

Question: What are the red flags to look for when evaluating a new PBM?

Answer: As with any partner that has an impact on your financial performance, transparency needs to be at the forefront of that relationship. Major red flags include complex discount structures with no clear answer on savings, complicated contracts, and a lack of real-time reporting.

Question: What kind of financial offering should you expect from a modern PBM?

Answer: In the simplest of terms: something straightforward. Given that transparency is the north start for the evaluation process, anything beyond a clear “here’s what you’re going to pay per member, per month” just won’t do. This clearcut method of invoicing means you won’t get surprises with every monthly bill and you can predict your costs much more accurately.

I caution against PBM vendors with overly complex rebate structures that are highly changeable and layered. Instead, choose a PBM that is confident enough to offer real savings guarantees or returns on investment. 

Change Management & Implementing a New PBM

Question: What was the implementation process like, and how did your employees react to the change?

Answer: Change, especially when it affects team members, is nerve wracking. They associate any changes to their benefits with issues getting prescriptions filled, increased costs, and other experience hiccups.

None of these challenges came up in Eagle Transport’s switch with SmithRx. The SmithRx team worked hand-in-hand with mine to ensure that disruption was as minimal as possible and in most cases, non-existent. Over a three-month ramp period our employees transitioned over to programs where they save hundreds of dollars a month in co-pays, with many paying $0 a month for the first time. 

Because the SmithRx took a proactive approach to the transition and provided comprehensive enablement and educational materials to our members, my team got no complaints at all over the course of the transition. In fact, employees remarked to our CEO just how pleased they were with the savings they were seeing with every refill.

Question: What does the ongoing support and relationship with a modern PBM look like?

Answer: A modern PBM really operates like a partner, which makes an incredible difference in seeing real savings. SmithRx handles our outreach to members to get them on lowest-cost alternatives for their medications and with minimal to no involvement from the benefits/ HR team. That means they’re not just identifying savings opportunities, they're going out and getting them for us.

On top of that, the transparent, digestible reporting provided by a modern PBM has been a game changer for my team’s benchmarking and tracking. It allows us to hold our PBM vendor accountable for their promised savings.

Question: What advice would you give HR leaders about finding a vendor they can trust?

"Go back and ask your current broker partners, ‘I went to this really great conference and I heard a lot about PBMs and how some PBMs can be really innovative in their approach to prescription drugs. Can you please look into that for me and bring back to the table three options for a PBM that is not tied to our TPA?’ If your broker says, ‘You don't want to do that’, start questioning them. They are not at that point doing what is in your best interest. And if you're going to partner with a broker around something as important as benefits, you need to have them working in your best interest. Just like a PBM needs to be working in your best interest, I feel that wholeheartedly about any benefit provider, and if they're not willing to do that, then it's time to move on.”

Rena Carter

VP of Human Resources at Eagle Transport Corporation

Get in touch with one of SmithRx's pharmacy benefits experts to discover just how smooth (and fruitful) a transition to a modern PBM can be.