TIER 2 · OPEN ENROLLMENT · MEMBER-SERVICE ANSWERS
Read the Answer
Before Your Employees Hear It
A 2-page printable check for comparing what your PBM's member-service team will tell employees about 2027 pharmacy coverage with what your plan actually decided, before open enrollment closes. Free download. Sent to your inbox.
The 6 pharmacy questions employees ask every enrollment season
The 4 places their answers actually come from
A Match / Gap / Conflict side-by-side and two test calls
Paste-ready request for the script, FAQ, letters, and call report
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Built by Prescription Benefit Solutions, an independent pharmacy benefits consultancy. In 2025: 132 pharmacy benefit reviews for self-funded employers, averaging $469,000 in contracted savings per client.
A complete audit framework you can run in half a day.
WHAT IS IN THE WORKSHEET
PASS 03
Side by Side, Then Two Test Calls
Most employees hear about their coverage from a member-service representative reading a knowledge-base entry, the app or portal, automated phone messages, or a transition letter, not from the summary of benefits the plan approved. The check requests every one of those for your 2027 changes and asks which parts were written for your plan and which are standard for all clients.
PASS 01
The Six Questions Employees Ask
Open enrollment pharmacy calls cluster into six questions: whether a drug is still covered, what it will cost, whether mail order or a specific pharmacy is required, whether a prior authorization carries over, what it takes to qualify for a GLP-1, and what happens to a prescription already being filled. The check starts by asking the PBM how each will be answered for your plan.
PASS 02
Where the Answers Come From
Most employees hear about their coverage from a member-service representative reading a knowledge-base entry, the app or portal, automated phone messages, or a transition letter, not from the summary of benefits the plan approved. The check requests every one of those for your 2027 changes and asks which parts were written for your plan and which are standard for all clients.
ACTION PLAN
Correct in Writing, Then Read the Calls
Every Gap or Conflict goes back in writing with three asks: the revised answer, the date it takes effect, and the escalation path for questions the script does not cover. After January 1, the first 30 days of member-service calls grouped by reason show which decisions were explained well, weeks before claims data shows anything.