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Member Experience in Part D: An ounce of prevention is worth a pound of cure...

As we careen toward the beginning of the new plan year, don’t forget to think about member outreach for formulary changes effective January 1, 2021. Although members would usually be eligible for a transition benefit, it is a best practice to reach out to members affected by formulary changes to advise them of not only their eligibility for a transition supply, but also instructions on how to either pursue a coverage determination to continue their current medications (which may have new utilization management restrictions) or to speak with their prescriber about a potential change to a formulary medication.

The pharmacy benefit manager (PBM) can provide a disruption list of health plan members subject to formulary changes and the plan can either complete outbound calls, email notifications or mailed letters. Especially when the majority of the US is still battling increased COVID19 levels, members may not want to schedule an in- person prescriber visit to change their current medications. Member satisfaction is the name of the game in ensuring loyalty and continued enrollment. Make it easy for members to adjust to changes.

If Rebellis Group can assist you with a disruption analysis or other challenging Part D issues, please reach out at


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