Benefit Plan Changes

Intelligent targeting and tailored communications about formulary or pharmacy network changes can ease the transition for affected members.

Differentiated Approach for a Seamless Transition

Predictive Modeling Capabilities

When a plan makes a change to benefits, pharmacy data can tell us how many members may be affected; for instance, who may need to change a prescription or move to a new pharmacy.  

Because understanding member needs is so important for a smooth transition, we not only use existing data, but go a step further and employ predictive modeling to help us better understand and anticipate member disruption. Data from previous transitions as well as baseline knowledge about a member population enables us to predict how individual members will respond to a change and identify those who may need more focused attention. Predictive modeling also helps us ensure that member communications contain the right message to drive desired behavior and can be targeted and timed for when they are most effective. The Health Engagement Engine helps us reinforce messages about the change and appropriate actions at every touch point.

Targeted Multi-channel Communications

There is no one-size-fits-all strategy, and depending on the challenges an individual member may face, we may employ a combination of communication channels over an extended period including direct mail, email, or outbound live or interactive voice response (IVR) phone calls. This intelligent targeting helps make the best use of resources, reduce extraneous communications and concentrate on those that will be most effective. When necessary, we also reach out to prescribers to assist with prescription changes for members affected by formulary transitions.

From Members, for Members

We conduct ongoing focus groups and consumer surveys to guide the development of effective and impactful member communications. We know from our extensive research what members want in the communications they receive from us including:

  • Very clear headlines
  • The reason for the change
  • A focus on solutions
  • Bullets and bold font for emphasis and clarity
  • Direct language without wordiness 
Considerations for your business
  • Does your current formulary strategy deliver the savings you want?
  • Are there opportunities for improved network performance, including better adherence?
  • Are concerns about member response keeping you from refining your plan design?
Have a question about our Benefit Plan Changes?

Other Member Experience programs


When welcoming new members, we work with clients to understand their plan members and their needs. For members with complex regimens — including those using specialty medications – our high-touch program is designed to conduct early, proactive outreach to help minimize concerns and ensure a seamless experience.


Unless otherwise noted, all data is from CVS Health Enterprise Analytics.

CVS Health uses and shares data as allowed by applicable law, and by our agreements and our information firewall.