Ask prospective PBMs these six questions before you sign the contract:

How will you match our current formulary? Coverage gaps create chaos. Your PBM should be able to mirror your current formulary, or clearly explain where and why they cannot, with mapped alternatives and clear employee communication.
Can you replicate our existing pharmacy network? Forcing employees to switch pharmacies is one of the most personal and avoidable disruptions. Your PBM should match the existing network (or better yet, expand it).
Will you review our summary plan description and claims data to identify gaps or mismatches? A good PBM spots discrepancies early and helps fix them before they become legal or operational landmines.
What’s your process for converting specialty medications? Specialty medications aren’t plug-and-play. They require coordination across doctors, patients, and pharmacies. Your PBM should explain who handles what, and when.
How and when will our employees be notified and supported during the switch? Employees need clear, timely, actionable communication. That means more than just getting ID cards in hand. The PBM should notify pharmacies ahead of time, ensure prescriptions are transferred without disruption, and equip employees with simple FAQs and a real person they can call for support.
What does your support model look like in the first 30 days? The first 30 days will make or break the transition. Expect daily reject reviews, proactive pharmacy outreach, real-time troubleshooting, and complete transparency. Anything less is a red flag.

Seamlessness should be invisible

When PBM transitions are done right, your employees do not notice.

Instant Insights /

Feeling stuck with your PBM? Ask these 6 questions before you switch

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