Member Experience vs. the Great Resignation: Three moves to improve UM

Renee Rayburg, RPh
March 4, 2022

What is the point of negotiating stringent contract terms and conditions if no one ensures the rules are followed? Strategic vendor oversight is the independent referee who knows the rules and makes sure they are followed. PBMs are businesses with demands just like you to maximize revenue and reduce expense. However, business drivers must not diminish what is in an organization’s best interest.

Vendor oversight by a third party offers clinical and market expertise to assess the impact of recommended program changes. With continual monitoring of market changes, organizations become equipped with proactive knowledge of the drug pipeline and the latest clinical research on medication effectiveness. Plan sponsors need to validate the PBM recommendations support both member satisfaction and the bottom line.

For businesses like PBMs, customer satisfaction scores are essential indicators of customer loyalty and their likelihood of renewing contracts. They are also a barometer for PBM performance and provide the feedback necessary to make changes before it is too late.

In the competitive PBM marketplace, customer satisfaction is a key differentiator. Drug benefit management has grown increasingly complex, and plan sponsors depend on PBMs to seamlessly deliver services while maintaining employee and member satisfaction.

Because of this, relationships have to develop over time. Like all relationships, they can decline if expectations are not met. They can also flourish with mutual respect, alignment, service, and communication.

PSG’s Pharmacy Benefit Manager Customer Satisfaction report explores more than 40 dimensions of PBM customer satisfaction from the viewpoint of employers and health plans.



Spotlight on utilization management

Utilization management (UM) programs are a vital tool in the clinical and cost management of drugs. These programs are offered in various forms by most PBMs. Typically, there is an additional charge, but the value proposition purports these programs save overall costs by ensuring appropriate utilization. Because of their importance, this year’s report takes a closer look at satisfaction with UM programs.


Three themes emerged when respondents shared what PBMs could do to improve satisfaction with UM programs:

1.     Lower or no cost for programs
2.    Better reporting
3.    More thoughtfully approaching improvement of member experience



The current UM landscape

More than two-thirds of respondents reported they currently use prior authorization (PA) (88%), formulary exclusions (87%), step therapy (85%), and opioid management programs (69%).

The least frequently used program is gene therapy financial protection programs (13%). It also has the least awareness (36% not aware if offered by PBM).

No significant differences by size of PBM were found.




Download the 2022 PSG Complete Playbook for Renee’s recommendations on working toward a winning member experience.

Renee Rayburg helps lead Artemetrx services in Clinical Consulting with more than 30+ years in pharmacy and medical benefit management to support our health plan sponsors, providers, and patients.  Her thought leadership and passion for specialty pharmacy continues to influence the market, including important changes to specialty vendor clinical management products for the betterment of clients.