The Modern PBM Experience: Key Criteria for Account Support and Member Service

HR and benefits leaders today understand that selecting a Pharmacy Benefit Manager (PBM) is about more than just managing costs—it’s about delivering a streamlined, supportive experience for both their organization and members. With rising healthcare costs and an increasing demand for transparency, employers are looking for PBMs that provide exceptional account support, proactive member service, and data-driven tools to help them make informed decisions.

In this blog, we explore the key criteria that today’s employers prioritize when choosing a PBM, highlighting the modern services that set them apart from legacy providers.

White Glove Support: Setting the Standard for Modern PBMs

One of the most important criteria for employers when selecting a PBM is the level of account support provided. Modern PBMs recognize that exceptional account support is about more than just answering questions—it’s about providing proactive, high-touch service that anticipates client needs and addresses challenges before they become roadblocks.

Legacy PBMs often fall short by offering a one-size-fits-all approach, which leaves employers to navigate the complexities of their benefits plan on their own. They may also struggle to understand the true costs of prescription drug benefits due to opaque pricing models and a lack of personalized support. In contrast, modern PBMs prioritize comprehensive and personalized account support, ensuring that employers always have a reliable point of contact.

What to Look For in Account Support:

• Dedicated Account Managers: A designated resource who understands your unique needs and serves as a strategic partner, ensuring consistent communication and personalized guidance.
• Detailed Issue Resolution Process: A clear, transparent process for addressing account issues, supported by advanced tools that streamline communication and track progress.
• Response Time Guarantee: Modern PBMs commit to fast, reliable service, minimizing wait times and maximizing productivity.
• Intuitive Technology and Data Integration: Real-time data access through user-friendly portals empowers employers to resolve escalations quickly and make informed decisions.

These features set modern PBMs apart, providing a level of service that goes beyond traditional account management to deliver proactive and tailored support.

Elevated Member Experience and Service

While account support is crucial, a positive member experience is equally important when evaluating a PBM. Legacy PBMs often fail to provide the exceptional service and personalized care that today’s members expect. Long wait times, lack of access to vital information, and confusing benefit structures can lead to frustration and poor engagement.

Modern PBMs set a new standard for member experience and service by prioritizing proactive communication, transparency, and personalized support. They empower members to easily manage their benefits, access critical information, and receive timely assistance through multiple communication channels.

Key Features of a Modern Member Experience:

• Disruption Reports and Mitigation Plans: Proactively identify potentially impacted members and provide a clear plan for minimizing disruption, ensuring continuity of care.
• Member Satisfaction Tracking: Collect and analyze member feedback to continuously improve service quality and maintain high satisfaction rates.
• Multi-Channel Response Times: Guarantee timely support through phone, email, and digital platforms, ensuring members receive the help they need when they need it.
• On-Demand Technology and Data Access: User-friendly portals provide members with real-time access to benefits information, empowering them to make informed healthcare decisions.

By prioritizing these elements, modern PBMs enhance employee satisfaction and drive better health outcomes, setting a new benchmark for member experience.

Cost Efficiency and Savings Programs

Employers are under increasing pressure to manage rising healthcare costs, making cost efficiency a critical factor in choosing a PBM. Legacy PBMs often rely on complex pricing structures and hidden fees, which can drive up costs without delivering additional value. In contrast, modern PBMs provide transparent pricing and implement cost-saving programs that are aligned with the best interests of both employers and members.

What to Look For in Cost Efficiency Programs:

• Clear and Transparent Pricing Models: Modern PBMs provide detailed breakdowns of costs, including administrative fees and drug prices, ensuring employers know exactly what they’re paying for.
• 100% Pass-Through Rebates: Rebates and discounts are fully passed through to employers, reducing overall drug costs.
• Cost-Containment Initiatives: Programs designed to minimize spending, such as formulary management, utilization reviews, and low-cost alternative pathways.
• Specialty Drug Savings: Comprehensive strategies to manage high-cost specialty medications, including biosimilars and cost-effective sourcing options.

Modern PBMs leverage these strategies to provide significant savings while maintaining high standards of care and access for members.

The SmithRx Difference: A Modern Approach to PBM Services

SmithRx stands out by delivering a modern PBM experience that meets the needs of both employers and members. Our approach focuses on proactive account support, seamless member experiences, and cost efficiency through transparent pricing and innovative savings programs.

Account Management Team
At SmithRx, each client is paired with a dedicated account manager who acts as a strategic partner, ensuring consistent communication and personalized guidance. Our proactive approach includes a response time guarantee for 90% of communication, so employers always receive timely support. We provide transparent issue resolution with advanced tools that streamline communication and track progress, ensuring no detail is overlooked.

Support Team Excellence
Our support team is known for its industry-leading response times and expertise. With PharmDs available for complex clinical consultations, we proactively engage members to offer guidance and support before issues arise. This approach minimizes disruptions and enhances the member experience.

Intuitive Technology and Data Access
SmithRx provides real-time data access through our user-friendly partner portal, empowering clients to make informed decisions quickly and effectively. Our technology enables employers to resolve escalations swiftly, optimize benefit strategies, and identify cost-saving opportunities with ease.

Cost Efficiency Through Connect 360
Connect 360, our suite of cost-saving programs, actively guides members to the most affordable medication options, ensuring they receive the care they need without unnecessary costs. We continuously seek new discounts and provide transparent reporting, so employers can see exactly where savings are realized.

This commitment to comprehensive account support, exceptional member service, and cost efficiency ensures that employers receive the best value from their pharmacy benefits plan.

Ready to Experience the SmithRx Difference?

Choosing the right PBM is about more than just cost management—it’s about delivering a seamless, supportive experience for your team. At SmithRx, we provide modern solutions that empower employers and enhance member satisfaction, backed by proactive support and transparent savings.

If you’re ready to take control of your pharmacy benefits and see how the modern PBM experience can transform your plan, let’s connect.

Contact us today to learn more about how SmithRx can support your organization’s goals.