1/1 Readiness: 5 Tips for Smooth Transitions & Renewals

While the new year often evokes thoughts of new resolutions, renewal, and festive gatherings, HR and benefits teams may have a different take: it’s stressful. January 1st marks the effective date for pharmacy benefits and with potential changes comes a whole slew of questions and escalations. It’s an adjustment period that can be challenging for both HR teams and employees. 

What’s the key to making 1/1 go off without a hitch? Preparation and proactive, clear communication are key to minimizing member frustration and unexpected issues. Given how diverse employee populations can be, that’s no small feat—and it’s essential to have competent benefit partners by your side to navigate these transition periods.

We asked our strategy experts at Smith for their essential 1/1 readiness tips and tricks that’ll be sure to make your New Year stress-free.

1: Finalize Benefit Decisions Early On

2025 open enrollment preparation has been a huge wake-up call for most employers—2026 is poised to see huge increases in health plan costs. It’s crucial that going into open enrollment employers have: one, the right pharmacy benefit manager (PBM) partner by their side to help curb these costs, and two, a proactive cost-containment strategy and a plan to communicate any changes to members.

If you’re switching PBMs, this communication strategy is a massive undertaking that takes months of planning, but even simple changes or adjustments during a standard PBM renewal should be communicated effectively and often to ensure your members are never taken by surprise. 

There are some key details that should be ironed out well before enrollment season so you can strategize for the new year and inform members accordingly:

• Review Financial Performance: Nearing the end of year, there should be no surprises regarding your plan’s financial performance. You should be getting clear, actionable reports from your PBM to inform benefit design adjustments.

• Determine Cost Sharing: Given the historic rise in benefits costs, it’s smart to carve out time to think through and discuss cost sharing with your stakeholders and leadership team. You’ll need to decide whether to absorb premium increases or pass them along to employees. Strategize around cost tradeoffs to keep employee premium increases minimal while managing the overall budget.

• Optimize Existing Benefits (for Renewals): If you’re renewing with your current PBM, explore and activate additional cost-saving levers or programs that you may not have opted-into or utilized previously. 

• Finalize Optional Coverage: Do thorough research and make decisions on optional categories like GLP-1s as far in advance as possible, given their high demand and cost. If you’re considering limiting coverage, investigate alternatives like covering oral weight management medications or increasing HSA contributions to offset the impact for members. 

If you’re working with a modern, aligned PBM, you likely won’t need to bring any of these topics up—your PBM will be proactive with giving strategic advice to all of these points and can help you regularly evaluate and adjust your plan according to your needs come enrollment. 

2: Have a Proactive & Repetitive Communication Strategy

When it comes to pharmacy benefits, there’s no such thing as overcommunication. Even the smallest of changes can have a big impact for individual members, so it’s important to have a thorough communication strategy heading into January plan adjustments. Communication is the most critical factor in preventing 1/1 stress and maintaining member satisfaction. Employees do not like surprises when it comes to getting access to their medications. HR teams need to be the experts: they have to understand PBM changes and translate (and communicate) the impact to employees in a digestible way.

When communicating to employees, focus on the “so what.” Clearly outline what changes have been made (e.g., coverage, formulary adjustments, copay changes) and what that means for the employee. For example, if a drug is no longer on the formulary, outline the action a member needs to take: contact their doctor, so they can prescribe an alternative that is on the formulary. Most members likely don’t know what a formulary or clinical alternative is—so these need to be approachable, educational communications that clearly outline what they need to know and do. Even something as simple as repetitively stressing to members that they must present their new ID card and processing information to the pharmacy for every fill starting 1/1 is crucial: a failure to do so is a top reason for day-one call-ins.

When you’re thinking about how you’ll deliver these communications, keep your employee base in mind. Tech-forward, corporate companies may prefer digital communications, while others, such as those in manufacturing or trades, may be better served with traditional channels like letters or phone calls. 

Finally, we’ve found at SmithRx that there’s a timeline sweetspot for communications to members. Our clients have seen success with beginning high-level communications in early December (30 days prior to 1/1) to give employees time to act without being too early to forget. Repeat messaging both before and after 1/1 to address those who maybe missed your initial wave of communication due to the distractions of the holiday season. 

3: Promote Member Self-Service Resources

Empowering members with self-service tools reduces their dependence on HR or call centers—and it can provide them with instant answers. In your communication strategy, be sure to promote digital resources your PBM offers such as:

• Digital ID Cards: Employees should be encouraged to access and download the digital versions of their ID card/ benefits card from the member portal. Pro tip: members should also be advised to add these to their Apple/ Google Wallet for easy access.

• Formulary Lookup: If your PBM has one, highlight their formulary lookup tool within the member portal. These types of tools allow members to search for their current or new medications and see clinically appropriate alternatives instantly.

• Find My Meds: At SmithRx, we make finding the cheapest medications available on 1/1 a breeze. Since drug prices (from manufacturers/wholesalers) often change without warning on January 1st, our Find My Meds tool can help members quickly find the best current price nearby if their out-of-pocket costs suddenly fluctuate.

4: Align on SLAs & Post-Go-Live Support

If you’re transitioning to a new PBM, you must set clear expectations and SLAs for the implementation and post-go-live period to prevent frustrations due to misaligned service levels. Misaligned expectations are a major source of HR team frustration during January transition periods. 

First, confirm implementation status by pushing your PBM partner for firm timelines on key items, especially member-facing items like ID card production and delivery. A late ID card is a major disruption for members—and a major headache for HR teams. Second, it’s essential to define and communicate success metrics with your new PBM. Is success happy members, cost savings, or a balance of both? Use these goals to create measurable KPIs that you can use to hold your PBM accountable.

Finally, discuss and document explicit service standards for the transition:

• Responsiveness: What is the expected response time for escalations the HR team raises to the PBM?

• Post 1/1 Support: How will the PBM increase staffing to handle the expected surge in calls and inquiries immediately after 1/1?

• Breadth of Support: How will the PBM be reachable by members? Do they provide 24/7 support? Are there multiple options for communication including chat, phone and email? What sort of self-serve options are available?

5: Contextualizing External Benefit Changes

While your PBM focuses on pharmacy coverage, it's helpful to understand changes occurring across your entire benefits portfolio, as these changes can indirectly impact member experience and pharmacy utilization.

Coordinate with your PBM partner to ensure they’re up to speed with any changes you’ve made going into 1/1, such as adding new services like care management, navigator programs, or even a separate weight management company. This broader context helps the PBM better serve your members.

Additionally, note any significant changes to your medical benefits, as pharmacy is deeply interconnected with medical benefits and changes on one side can influence the other.

Successful 1/1 readiness hinges on detailed planning, especially if you’re navigating a PBM change. If you've recently selected a new partner, or if you simply want assurance that your current PBM's support plan is comprehensive, the time to review your implementation strategy is now.

Thinking about making a change this year, but nervous about the implications of PBM swapping? Watch our webinar on navigating PBM transitions with ease and get our tools to begin your transition, here.