Implementation: Putting It All Together

Implementing a new prescription benefits plan can be a challenge; however, it’s also full of opportunities. The question is how to fully capitalize on those opportunities as a benefit plan decision maker. So, how do you know you’re getting the most from your prescription benefits plan implementation?
It starts with the relationship you and your PBM work together to build. That relationship grows as the PBM explains its programs and services with the end goal of documenting your new plan design. For plan sponsors, implementation is a chance to learn about prescription benefit options in greater detail, consider decisions that will affect your members, and discuss potential ways to save on total plan costs. As key advisors to plan sponsors, brokers, consultants and third-party administrators (TPAs) also contribute to and guide plan sponsors during implementation. Members also have a stake due to potential plan design changes made during implementation that may affect them.

Prescription benefits are just as important as medical and dental/vision benefits within a total benefits package used to attract and retain key employees – but historically not all of these benefits are treated equally during implementation, especially when plans change medical and prescription benefit providers at the same time. However, no matter how much emphasis is placed on the prescription benefits portion of benefit provider changes, the right guidance from a PBM enables you to make choices that will lead to what your specific plan wants to achieve.

Considering the traditional model many PBMs use to implement new business – where benefit decision makers go from working with sales executives to account managers or implementation departments with brief flashes of other intermittent PBM contacts in between – it’s not exactly easy to build a solid PBM/plan sponsor relationship. To bridge the gap, some PBMs offer clients a guide to read before implementation meetings start. The intention is to give you an information base, but, in reality, prescription benefits are complex; plan sponsors should have more than ten pages to make well-informed decisions during implementation. The industry standard of a strict 90-day implementation timeline can also be a barrier to building a strong PBM/plan sponsor relationship. Once 90 days are over, you’ll probably move on to yet another PBM contact for ongoing support.

While the established legacy of how PBMs and plan sponsors interact during implementation has its merits, it also has room for improvement. With efforts focused on offering flexible designs for each unique plan, Innoviant recognized an opportunity to enhance our implementation process. We now utilize a dedicated team to exclusively assist new clients during implementation – a popular practice in the TPA industry. Our team explains all aspects of Innoviant programs and services from beginning to end throughout the process, helping plans transition more smoothly to a new pharmacy benefit provider. In addition to the team, plan sponsors also interact closely during implementation with the Innoviant account manager who will support them once the transition is complete; however, the door is always open, and clients can still access the implementation team for additional support even after the move to Innoviant is complete.
Implementation guides can be helpful tools, but are most useful when they thoroughly detail all information covered during implementation, from co-pay options to financial arrangements. In addition to laying an improved foundation for relationship building, Innoviant also enhanced our implementation guide to be all-inclusive, covering everything touched on during implementation. The new guide is easier for clients to navigate and quickly find information. Because of its comprehensive nature, clients may also use it as a reference manual well beyond the initial implementation period.

Empowering all benefit plan decision makers is crucial during the implementation process. A PBM’s team interaction and supporting materials are just the first steps to partner with you through implementation. Each plan is one-of-a-kind and has different goals, so the PBM needs to work with you to define what you want to achieve with your new plan and then apply its resources to best ensure your plan reaches its goals. Every PBM should ask about a plan’s goals early in the implementation process. For example: 

• Is offering your members multiple choices important, such as enabling them to choose between filling 90-day medication supplies through either mail order or retail pharmacies?
• Are you open to adding programs with high savings potential even if they weren’t part of your previous plan design? For instance, a specialty pharmacy program or something like Innoviant’s Generic$ Rx that enables members to use certain generic medications at little or no out-of-pocket cost to them while still yielding significant plan savings despite lower member contributions.

Prior to an effective date, PBMs should offer clients as much time before (and after) the plan officially starts to get acclimated and carefully decide what’s best. Cookie cutter implementation timelines like the 90 days prior to the effective date used as an industry standard by many PBMs can impact plan success. As such, Innoviant introduced more flexibility to our process to implement plans in more – or less – than 90 days. Because of this malleable ability to apply internal resources according to each plan’s expressed goals, Innoviant has accommodated implementations in as long as six months and as few as two weeks. For example, if a plan wants a strong emphasis on consumer driven health care (CDHC) options, such as Innoviant’s Wise Choice Rx program, its implementation may take longer than 90 days so it can include a communications campaign to promote CDHC programs to members. In contrast, when plans join Innoviant through sister TPAs, the implementation process can be streamlined to well under 90 days because of the best practices that already exist between the organizations.

Lisa Gish, executive director of the Tri-State Business Group on Health, a non-profit health care association, represents 58 companies in Southwest Indiana and Northwest Kentucky. Gish has guided clients through new prescription benefit planning with several PBMs, including Innoviant. According to Gish, if a plan gets the opportunity to work hand-in-hand with an involved PBM during implementation, it really, “forces the plan into action. It definitely generates a more active participant in the end.”

Gish reviews implementation material with member organizations prior to and during implementation meetings. “Plans have so much thrown at them. It’s a proud moment to see a company get more involved and engaged with its benefits. When a company is allowed the time to think about and explore options, it generates a level of involvement as a consumer that moves the company forward with its prescription benefits at a quicker pace.”
So, how do you know if an implementation is taking advantage of all of the potential opportunities inherent to the process? According to Lisa Gish, you’ll know implementation of a new benefit plan is a success when “you walk away with a deeper understanding of prescription benefits and what your plan is providing to its members.”

Implementation is an opportunity to put everything together and direct your plan toward your ultimate destination. Having a strong relationship with your chosen PBM is a sturdy foundation for building plan success. Look for a prescription benefit provider that will help you overcome the challenges of implementing a new prescription benefit plan. Only then will you know your new prescription benefit is designed with your goals in mind and will ultimately be rewarding for you and your members.