Navigating High-Stakes PBM Change with People-First, Empathetic Service

Most HR professionals will oversee a pharmacy benefit manager (PBM) transition maybe only once or twice in their careers. The industry is dominated by players that have made the idea of changing PBMs a frightening one. Information about transitions is scarce, evaluating the true value of your current PBM (if they’re legacy) can be murky, and businesses keep their cards close to their chest, so understanding the process is difficult to say the least.

Beyond most folks feeling under-educated or resourced on PBM transitions, there’s also a fundamental fear that any sort of change will cause major employee disruption and result in care gaps. That fear is totally valid: it’s nerve wracking to have the health of your business’ employees in your hands. Though specialty patients make up a small number of most plan membership (think 1-2%), they represent the most ill among us. These include employees with chronic conditions, or ones dealing with diagnoses like oncology or rheumatology, that likely take several medications. The worry you’ll disrupt care for these folks is reasonable—and it’s crucial your PBM partner is on the same page.

How a PBM handles these transitions, as well as their ability to deliver exceptional value to even the most complicated of patient cases, is a true test of them as a partner. It’s my belief that the only way to properly navigate these transitions, and the client-PBM relationship in general, is with a people-first, empathetic service strategy.

Leveraging Empathy as an Operational Guarantee

Almost every business we serve at SmithRx is coming to us from a legacy PBM. The practices of legacy benefit managers have left our clients in a daze—and that’s by design. The legacy model is predicated on opacity and complicated vertical integration. Clients have been made to fear anything new or different because these legacy organizations are so large and far-reaching that they almost seem like they're the only viable option for enterprise businesses. 

That’s categorically false—and we know that. It’s my team’s job to replace their nervousness with certainty. We know pharmacy benefits inside and out, we’ve helped businesses like theirs before, and we’re confident in the value we can bring. 

I’ve found that establishing trust at the beginning of a new business relationship is two-pronged:

1. Established Expertise: We know what we’re doing at SmithRx and we’ve been doing great things for nearly a decade at this point. Beyond that, we’ve built a team that is incredibly well rounded and filled with employees who have backgrounds outside of just benefits: we’ve got folks with pharmacy and medical backgrounds who truly understand just how awful the industry can be on businesses and patients. With that full breadth of business and medical expertise, we can confidently say we know exactly how this works and we’ve been through this before.

2. Process Transparency: Where legacy PBMs can share too little, we believe in being very candid about our processes, data, etc. My team starts off by sharing our operational roadmap and really digging into the ‘why’ behind our processes. Reassurance comes from detailing what we do and when we do it: how prescriptions are transferred, how members are set up, and the exact timing of outreach. It’s here where you can really prove out that they don’t need to be worried about their members: we’ve got it and we have the plan to back that confidence up.

Proactive Communication That Builds Trust

Simply giving clients a ton of information isn’t always enough to repair their broken trust with PBMs. They’re often coming from adversarial relationships with legacy pharmacy benefit managers, and so they have no reason to trust us. It’s crucial that transparency is backed up with great communication.

The key to building trust is in frequent, balanced communication. Often, HR leaders only hear about the problems their members are facing or huge escalations. It’s our job as advisors to provide the full picture of what's actually happening using data on successful fills, member calls, and service wins.

On top of communicating wins, you also need to communicate the not-so-great information in a timely manner. The fastest way to build trust is by proactively identifying and solving potential concerns before the client even asks. This shows we're not hiding from problems but tackling them head-on, proving our competence and transparency. I think this is what really sets us apart as a modern PBM: we don’t hide behind reports of ‘amazing’ discounts, and instead, we communicate the good, the bad, and what we’re going to do to overcome challenges and deliver exceptional results.

Listening to Understand and Uncover Real Issues

Empathy has the ability to identify true business problems when speaking with clients because it allows us to move beyond surface-level complaints to get to the heart of issues. This starts with a simple mantra: listen to understand, not to respond. When a client calls with an escalation or complicated question, the goal isn’t just to provide a quick answer; it’s to deeply listen because often, what they’re saying is a symptom of the underlying issue. 

I recently encountered a perfect example of this during a call with a client who was finalizing contracts with us. A member of their finance team wanted to discuss a specific blurb in the document. My immediate, preconceived notion was that they were concerned about complicated financial concepts. I walked into the conversation expecting one thing, but by starting high-level and asking an open-ended question—"Tell me more about your question"—I discovered the problem was something else entirely: they just wanted a high-level overview of how our rebates work.

This is the power of strategic empathy. By pivoting from my assumption to their actual question, we uncovered a fundamental lack of understanding about the rebate process—a foundational misunderstanding that would have eroded trust later on if left unaddressed. We had a conversation explaining how claims are submitted, how SmithRx processes them, and how claims get rebated. By the end, they related that they, “really understood it and got it”. Getting off of that call knowing the client felt more comfortable than they had previously was a win.

Though a small victory, it speaks to the ROI of empathy. It teaches us to start high-level, gauging the client’s knowledge baseline. This approach allows us to pivot to solve the real problem, avoiding over-explaining and, more importantly, cementing a valuable partnership by customizing our communication. If you start with too much detail and they don't understand the basics, you've already lost them.

In a high-stakes industry like pharmacy benefits, a people-first approach is not just a ‘warm-fuzzy’—it is the strategy that drives superior business results. Our approach at SmithRx uses empathy to replace clients’ fears with confidence, build trust in our proactive communications process, and inform our listening style to truly understand clients’ issues. 

We’re confident that when you navigate these high-stakes situations with genuine care and empathy, you don’t just provide a service; you become a true, trusted partner that can deliver meaningful results.