Considering a New PBM?
Here's What You Need for a Smooth Implementation

Gary Golebiewski, MBA
November 14, 2019

Plan sponsors are concerned about the turbulence in the prescription drug marketplace, particularly the recent alliances between major PBMs and insurers. Since 96% of American pharmacy spend passed through a PBM in 2017, this market upheaval has health plans and employers considering new options for a PBM. In fact, over the past three years, about half of the clients for whom we have managed procurements have changed PBMs.

Choosing the right PBM is only half of the equation, however. A seamless implementation is just as important in order to minimize member disruption and ensure program accuracy. For these reasons, many health plans and employers who used another consultant for procurement are seeking PSG’s PBM implementation expertise and experience to manage the actual transition.

Best practices for PBM implementation
Even if you used a consultant to procure a new PBM, you might find value in selecting a different consultant — one with expertise in PBM transitions — for the actual implementation. If you choose this route, you’ll want to look for a provider who:

  • Focuses on pharmacy. Your implementation provider should be an expert in pharmacy benefits so you receive custom, detailed attention that addresses your needs, including the clinical aspects of your transition, rather than a “template” service that a non pharmacy-specific firm may use.
  • Follows industry best practices for project management. For example, PSG’s proprietary project management systems follow principles in the Project Management Professional (PMP®) phases as certified by the Project Management Institute (PMI®).
  • Has the tools and expertise to support testing throughout the implementation to ensure a smooth, accurate transition to the new PBM.
  • Provides both pre- and post-implementation audits to assess whether the contract terms, pricing, and other key components with the newly-selected PBM are being adjudicated as agreed. This will ensure that the plan design parameters are accurate and none of your pharmacy program dollars are being wasted.
  • Evaluates the success of your implementation and applies lessons learned from previous PBM transitions to future projects. The project evaluation typically is conducted to answer these three questions:
    • Did the project deliver on time, within budget, and to scope and quality requirements?
    • Were project stakeholders and project team members satisfied with the project?
    • Did the project achieve the envisioned business benefits?

Even if you’ve signed with a new PBM but yet have to make the change, turn to PSG. Our industry-leading support means a seamless transition for your members and accurate implementation for your plan.

Download our PBM Vendor Procurement and Management overview to learn how we help plan sponsors get the most from their PBM.

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Gary Golebiewski has 20 years of experience in the health plan, pharmacy benefits, and insurance industries. His key skills include developing and maintaining strategic account relationshipsdelivering client-specific plan design and cost savings recommendations, as well as negotiating beneficial pricing and contracts for his clients.