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Top 6 Questions We Receive About Implementing New PBM Groups
Implementing a new pharmacy benefit management (PBM) solution can be daunting, with numerous factors to consider and potential pitfalls to avoid. As Account Executives at Serve You Rx, we help countless clients navigate implementing new PBM groups. Along the way, we gain valuable insights. In this article, we’ll share the top 6 questions we receive about implementing new PBM groups and provide guidance based on our experience.
Implementation Timeline: What factors influence the speed of implementation?
We can implement new PBM groups in as little as 30 days, depending on the complexity of the plan design, the receipt of signed documentation, and existing connectivity with the desired Third Party Administrator (TPA). Generally, implementation of new PBM plans takes about 90 days. However, we have successfully implemented new PBM groups in 30 days or less, as warranted.
Factors that influence speed and timelines include:
- Open enrollment dates
- The timing and nature of the plan sponsor’s desire for member communications
- Details provided and complexity of plan designs
- Receipt of signed documentation
- Existing connectivity with desired TPA
We create a tailored implementation plan and hold weekly status meetings to ensure a smooth and timely rollout. We are always ready, willing, and able to establish new TPA connectivity. You can view our current list of TPA integrations here.
Employee Education: What resources are available to help employees understand their new benefits?
Effective employee education is key to a successful PBM implementation. We provide various educational resources, including drug cost comparison tools, targeted mailings, formulary communications, and employee open enrollment support.
Plan Design Optimization: Can Serve You Rx review our current plan design and make recommendations? How flexible are you with plan design changes throughout the year?
Our experts will review your current plan design and provide recommendations to optimize cost savings and clinical outcomes. Most plan design changes can be completed within 7-10 business days.
Implementation Accuracy and Ongoing Support: How do you ensure a smooth implementation, and who will manage my groups post-go-live?
Our implementation process ensures a smooth transition for your members, with a 99.9% accuracy rate. We work closely with each client to develop a customized implementation plan, and your dedicated Account Executive leads the process, serving as your primary contact throughout the relationship.
Weekly status meetings are held during implementation to review progress and address outstanding items. Your Account Executive will document your benefit and operational requirements using our comprehensive implementation guide. Once completed and approved, our coding specialists configure the benefit plan, which undergoes extensive system setup testing, quality assurance evaluation, and regression testing before going live.
Following go-live, our team, including our clinical pharmacists, performs detailed claim auditing to verify accurate processing. Our pharmacists diligently review daily reject reports to identify and resolve potential issues, ensuring members receive their medications without interruption.
Reporting and Analytics: What type of reporting do you provide, and how much does it cost?
We offer comprehensive reporting, including high-dollar claim oversight, return on investment on clinical programs, and tailored cost containment recommendations. We also provide monthly, quarterly, and annual reporting that shows areas of concern, improvement, and clinical endpoints of interest. Additionally, we offer any number of data exchanges. This includes point solutions, healthcare data warehouses, or any other third-party clients may want to utilize. All these reports and data exchanges are available to our clients free of charge.
Rebate Management: How do you handle rebates, and what flexibility do you offer?
Rebate guarantee payments are typically paid quarterly, as are reporting details. However, we have the flexibility to pay rebates in other ways, including prospectively at the Point of Service or on a per-employee, per-month (PEPM) basis for clients who want more prompt payments to offset administrative or medical administrative fees. Whatever payment method is selected, we will provide the corresponding reconciliation reporting necessary to confirm contractual requirements have been met.
Implementing New PBM Groups
At Serve You Rx, we are committed to being your trusted partner in pharmacy benefit management. Our flexible, accurate, and supportive implementation process is just the beginning of a long-term relationship focused on delivering value and improving health outcomes for your clients and their employees.
Co-Authored by Account Executives Doug Hulsebus, Lisa Hoffmann, and Nabat Guarina
About Serve You Rx
Serve You Rx is a full-service pharmacy benefit manager (PBM) with unquestionable flexibility and an unwavering commitment to doing what’s best for its clients. With a fervent focus on those it serves, including insurance brokers, consultants, third-party administrators, and their clients, Serve You Rx delivers exceptional service and tailored, cost-effective benefit solutions. Independent and privately held for over 37 years, Serve You Rx can implement new groups in 30 days or less and say “yes” to a wide variety of viable solutions. Known for its adaptability, quality, and client-centricity, Serve You Rx aims to be a benchmark for better client service.
