Four Questions That Can Help Achieve an Unimaginably Great PBM Implementation

Posted on by myMatrixx
WCI Weekly

Switching to a new PBM is a big decision. Frankly, the time and resources it takes to go through the implementation process are enough to keep many plan administrators from making the switch, even in a less than ideal situation. But if generic substitution, unnecessary prescriptions, and low legacy claim closure — just to name a few of the issues caused by suboptimal PBM service — start to create exorbitant costs, moving to a new servicer can become a sound and necessary choice.

When it is time to switch, seamless implementation becomes priority No. 1. A smooth implementation can make the difference in achieving real value for your program.

Implementations is about delivering on a promise

Achieving a Successful PBM Implementation Article

WCI 2022 myMatrixx Article


A PBM can do all things it says it can do, but poor communication, inadequate training, or missed updates to pharmacies can prevent its capabilities from being fully realized. The implementations team are the first people who start to deliver on the promises that a PBM has made to get you to make that switch.

Even in the best cases, that will still involve some hurdles and pain points. One of the most common is simply helping navigate the uncertainty that comes with change. People get used to doing something a certain way and they are often reluctant to train on a new system, even if it’s a better system. Easing this uncertainty and building a bridge from one team to another is fundamental to any implementation strategy, and it’s a great example of the fundamental role good communication plays in delivering effective outcomes.

The implementations team should be able to adapt to any scenario, from simple to complex. But, preparation is key to a smooth transition. Any organization considering switching PBMs can start by asking a few basic questions that can help prepare for a smooth and productive implementation.

Asking the right questions is key for a smooth implementation process

  1. What are your strategic goals?
  2. What makes workers’ comp pharmacy unique?
  3. What should you bring to the table?
  4. What should the PBM bring to the table?

To get more insight into these questions, download our thought leadership article. You can also view the questions in the Workers' Compensation Institute's (WCI) digital newsletter.