4 proven ways to keep members happy during a PBM transition.

Switching PBMs has a reputation for headaches. Yet a transition can actually lower spend and elevate care when it’s engineered around member needs.

Below are four proven tactics we use to turn a high-risk project into a friction-free experience:

1. Design benefits that fit your workforce.

One-size-fits-all pharmacy plans just don’t work anymore. For some organizations, the priority is lowering costs by encouraging the use of generic medications, applying step therapy where appropriate, and guiding members toward high-value medications. When done thoughtfully, these strategies not only lower costs but also help members avoid unnecessary or overpriced treatments.

For others, the priority might be ensuring broad access, especially for members managing chronic or complex conditions. A wider formulary and fewer restrictions can provide continuity of care, reducing the risk of disruption during a PBM switch.

The key is balance. A strong plan meets financial goals without making members feel like they have to choose between affordability and access. When benefits are designed with the member experience in mind, transitions feel smoother and trust stays intact.

Takeaway: Tailor your pharmacy benefits to strike the right balance between cost control and access so members get the care they need without disruption.

2. Make smart formulary choices that protect the member experience.

Formulary changes are one of the most critical parts of any PBM transition. Done poorly, they can lead to member confusion, access issues, and frustration. Done well, they can create real savings without disrupting care.

The key is being proactive. In most cases, only a small percentage of members—often just 1–3%—are directly impacted by formulary adjustments. However, those members may require more hands-on support. For example, someone relying on an expensive biologic might need help transitioning to an alternative, getting a new prescription, or understanding their updated coverage.

By identifying affected members early and reaching out with clear, personalized support, you can deliver cost savings and ensure those members feel informed, supported, and confident throughout the transition.

Takeaway: Identify and support impacted members early to make formulary changes seamless and minimize care disruption.

3. Build a transition plan around real member pain points.

Every organization is different, and the PBM transition plan should reflect that. When switching PBMs, it's essential to identify where members have struggled in the past. Were there delays in mail-order medications? Confusion about coverage? Gaps in communication? Addressing these issues early helps avoid repeat pain points.

A strong, member-focused plan should include:

1. Stakeholder alignment to ensure everyone is on the same page.
2. Clear member communications that explain what’s changing and why.
3. Targeted outreach for impacted members, with timely, personalized support.
4. Pharmacy coordination to avoid disruptions to mail-order and specialty drugs.
5. Go-live testing to catch issues before they reach your members.

Takeaway: Use past challenges to guide your transition strategy and prioritize clear communication, coordination, and issue prevention.

4. Replace reactive support with proactive, personal outreach. 

Member support is where most PBM transitions fail, and great ones stand out. Support shouldn’t wait until members are confused or frustrated. The best PBM transitions include proactive outreach and real-time access to experts before, during, and after go-live.

Here’s what that can look like:

• Direct outreach, including calls, emails, and letters to members affected by formulary or pharmacy changes.
• One-on-one support from pharmacists who can answer questions and coordinate care.
• On-site or virtual office hours so members can speak directly with someone who understands their needs.

Takeaway: Provide high-touch, personalized support before members experience confusion or frustration.

A PBM switch doesn’t have to disrupt care, or your bottom line.

With the right playbook, employers can lower drug costs and deliver a smoother member experience. That’s the promise and practice of Rightway’s high-touch transition. Rightway’s pharmacy team personally guides every affected member, transfers prescriptions behind the scenes, and stays on call 24/7. Our hands-on approach delivers meaningful cost savings without compromising quality.