Helping members get a smooth start with their new PBM can improve satisfaction and results.

Seamless Transitions

We want all members to have a good experience with their pharmacy benefit from the very beginning.

We help to make sure they are appropriately engaged in managing their health and are getting the most out of their benefit, with a special emphasis on those with the most complex conditions. We analyze a plan’s population, their unique needs and communication preferences, and develop effective approaches to help them take action. 

1M total population, 58% currently filing a prescription. Of these, 29% filling acute only, 19% filling maintenance only, and 52% filling acute and maintenance.

Baseline knowledge about our new members helps us understand how they are using their pharmacy benefit. We evaluate available data and identify members who may need more focused attention, as they account for a significant amount of pharmacy spend. 

A High-touch Approach for Members with Complex Needs 

Transitioning to a new benefit can be particularly concerning for members with complex maintenance medication regimens and those taking specialty drugs. We have developed a high-touch outreach program for those members who could need extra attention. When these members transition to CVS Health as their new PBM:

  • We reach out to welcome them to their new plan in the first 30 days their benefit is active.
  • Customer Care representatives call them proactively to introduce their new benefits and answer questions. We highlight the digital tools available to them and send them a quick registration link to help speed the process.
  • The Specialty CareTeam contacts patients with specialty conditions to help transition prescriptions and highlight the clinical support available to them. For members who are prescribed both specialty and maintenance medications, we ensure their support is coordinated to help address all their needs.
Digitally-engaged members are more satisfied and more likely to be adherent. $23/yr lower medical costs for digitally-engaged members, 20% fewer calls about benefits.
Digitally-engaged members are more satisfied and more likely to be adherent. $23/yr lower medical costs for digitally-engaged members, 20% fewer calls about benefits.

Engaging Members Digitally 

From the Welcome Kit to conversations with Customer Care representatives, we focus on helping ensure new members connect to digital tools from the beginning. Representatives check whether members are digitally connected during calls, and send a quick registration link to those who are not to get them started. 

Ongoing Engagement

Whenever a new member joins the plan, our goal is to make them feel welcome and inform them about their benefits. Benefit Opportunity Specialists engage members identified as having unique opportunities to make better use of their benefit. Our technology seamlessly connects the member to a specialist when they make an inbound call. The specialist first addresses the issue the member is calling about, then introduces the new opportunity, which could be a money-saving prescription option or registration for digital tools. 

Considerations for your business
  • How many of your members use specialty medications or have multiple prescriptions? 
  • Could additional, targeted support help them make a smooth transition to a new PBM?
  • How can digital tools help your members manage prescriptions better and increase member satisfaction?
Have a question about our Onboarding programs?

Other Member Experience programs

Benefit Plan Changes

Changes to formulary or network design can help reduce costs, but may also be disruptive to some members. Targeted communications can help members understand the benefit change and why it’s being made. That way, they are more likely to make the best use of their benefit with minimal interruption to any ongoing therapy. 

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