How a Pharmacy Benefit Manager Can Help You Build Relationships that Matter

Patrick J. Finnegan
Manager of Pharmacy Support Operations


In our world of frequent advancements in medicine and complex pricing in healthcare, patients and pharmacy benefit plan members need all the expertise they can get. Learn where to find it.

In our world of frequent advancements in medicine and the complexity of pricing in our healthcare system, patients and pharmacy benefit plan members need all the expertise they can get. Pharmacy Benefit Management doesn’t just administer drug benefit plans; it should also provide high-quality customer service to improve the member experience and help ensure they’re getting the most suitable medication at the lowest cost.

Organizations of all sizes deserve the availability of a high-touch customer service model that helps keep their members healthy and out of the hospital, reduce member disruption, and contain costs.

Automation in customer service

Some PBM teams have started using automated tools to handle customer service issues, especially with small to mid-size employer groups. This leads to members not getting the help they need. Human Resource (HR) employees have had to bridge the gap in service and field issues for their employees, reducing the time they can focus on other tasks, and limiting the time of day to business hours that a member can speak with a live person. If people can’t get the medications they need when they need them, this reduces member satisfaction and could also have a negative impact on patient health.

Improving the member experience

When looking for a pharmacy benefit manager, organizations should focus on a partner that provides multichannel customer service, where members have the option to speak to a live person and aren’t forced into automated tools. Availability seven days a week throughout the year, as well as extended hours of operation, is of utmost importance to help ensure members can get the help they need on weekends and holidays. Make sure you’re asking for metrics on Average Speed of Answer (30 seconds or less is best), First Call Resolution (80% or higher is what to aim for), and their customer satisfaction scores. In addition to supporting the member, PBMs should also support the filling pharmacies and prescribers to help smooth out hurdles behind the scenes so everyone involved can ultimately shift their focus back to the member. Partnering with a Pharmacy Benefit Solutions organization, like Change Healthcare’s will help ensure a trusted relationship between our organization and yours to provide the highest level of customer service. Regardless of membership size, we’ll help drive increased member satisfaction and better health outcomes by being “present” to solve issues quickly, accurately, and comprehensively. HR and other employee-facing teams will have increased time available to focus on other pressing aspects of their jobs. We also understand the plans and how pharmacies and providers can best work with the plan to successfully process the claim and to get the member what they need.

Here for you when you need it

Change Heathcare’s Pharmacy Benefit Solutions is URAC accredited since October 2021. Members are supported by our Member Services Help Desk, which is staffed with plan experts and certified pharmacy technicians who have all the details of each plan at their fingertips and are focused on First Call Resolution. The Help Desk can also run test claims, prior to first-time orders or refills, to eliminate uncertainty regarding the cost or status of medication being prescribed for our members. We provide surveys at the end of each call, which reflect an overwhelmingly positive experience with our agents. We’re focused on bringing back exceptional service to the PBM model that will assist our customers in attaining the best possible management of their pharmacy benefit.

The Commercial Pharmacy Benefit Solutions organization is committed to Change Healthcare’s quest to enable a better, more efficient, cost-effective, and easier to understand healthcare system.  

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