Open Enrollment Success: Communicating Pharmacy Benefit Changes Effectively

Open Enrollment Success: Communicating Pharmacy Benefit Changes Effectively

Effective communication during open enrollment is not just a recommended best practice; it is a crucial component of successful benefits management for self-insured employers and their employees. Open enrollment represents a pivotal juncture in the annual benefits cycle, during which employees make vital decisions that directly impact their healthcare coverage. The significance of effective communication during this period cannot be overstated, as it has far-reaching implications for both the employees and the self-funded employers themselves.

Empowering Informed Decision-Making

Open enrollment provides employees with a unique window of opportunity to review and adjust their healthcare coverage to align with their evolving needs. This period is the lifeline of healthcare benefits, allowing employees to make choices regarding the plan that best suits them and their families. It is the time to select health insurance, adjust deductibles, choose prescription drug coverage, and decide on various other benefit options.

However, the gravity of these decisions is such that employees must make informed choices. The implications of these choices extend beyond annual premiums and co-pays. They can affect an individual’s access to healthcare providers, the scope of coverage, and the financial implications of different healthcare scenarios.

Employee Satisfaction and Engagement

The linchpin of effective communication during open enrollment is ensuring that employees are not only aware of their options but are well-informed and thoroughly understand them. This informed decision-making process is intrinsically tied to employee satisfaction. When employees perceive that they have access to clear, reliable information and resources to make educated choices, they are more likely to be satisfied with their benefits packages.

Moreover, informed employees tend to be more engaged in their healthcare decision-making. Engagement in health-related decisions typically leads to better healthcare utilization and healthier choices. For example, employees who understand the benefits of preventative care or the financial advantages of using in-network providers are more likely to make choices that not only promote their well-being but also reduce costs for both themselves and their employers.

Cost Savings for Self-Funded Employers

Effective communication during open enrollment has a direct impact on the bottom line for self-funded employers. When employees make well-informed decisions that align with their healthcare needs, it can lead to a more efficient use of healthcare resources. This, in turn, translates to potential cost savings for the employer.

For instance, employees who understand the nuances of their prescription drug coverage and pharmacy networks are more likely to select cost-effective options and follow recommended formulary guidelines. This proactive approach to healthcare utilization can result in lower pharmacy benefit costs and overall healthcare expenses for the employer.

The Challenge of Change

Pharmacy benefit changes are a common occurrence during open enrollment, often involving modifications in drug formularies, copayment structures, and network providers. These changes are typically intended to optimize the overall benefits plan by promoting cost-effective options, enhancing network relationships, and responding to shifting market dynamics. However, introducing these changes can be met with resistance and confusion among employees.

One of the primary challenges is that these changes often involve complex healthcare jargon and may necessitate employees to navigate new processes or choose different healthcare providers. As a result, employees can experience uncertainty, stress, and frustration. This can lead to suboptimal decisions during open enrollment and an overall reduction in employee satisfaction.

To address the challenge of change, employers and pharmacy benefit managers must prioritize effective communication strategies. They need to present these changes in a clear, accessible, and user-friendly manner. By doing so, they can help employees understand the reasons behind the changes and the benefits they can expect. This not only minimizes confusion but also encourages employees to make choices that align with the intended goals of the benefit changes.

Communicating Changes Effectively

1. Start Early

The key to successful open enrollment communication is starting early. Ensure that employees have sufficient time to digest the information and make informed decisions. Begin the process at least one to two months before the actual open enrollment period, providing employees with ample time to consider their options.

2. Clear and Comprehensive Documentation

Offer employees clear and comprehensive documentation that explains all changes to pharmacy benefits. Use plain language to describe the alterations and their implications. This documentation should include detailed information about prescription drug coverage, including cost-sharing, copayments, and any restrictions on medications.

3. Multiple Communication Channels

Utilize multiple communication channels to reach a diverse workforce effectively. Options may include email, printed materials, webinars, and in-person meetings. Remember that not all employees prefer the same communication method, so offering a variety of channels can improve accessibility.

4. Employee Education

Organize educational sessions or webinars to help employees understand the changes. These sessions can address frequently asked questions, provide real-life examples, and explain the benefits of the new plan.

5. Personalized Assistance

Offer personalized assistance through dedicated helplines or online chat services when possible. Some employees may have specific concerns or unique situations that require individualized guidance.

Typical Plan Changes: Pros and Cons

Formulary Changes 


  • Cost Savings for Employers: One of the primary advantages of proper formulary management is the overall cost savings it offers to the plan. By encouraging the use of generic medications over brand-name drugs, employees can enjoy reductions in their out-of-pocket expenses. Generic drugs are typically more affordable and provide the same therapeutic benefits as their brand-name counterparts.
  • Lower Copayments: Employees can save money by selecting medications from lower tiers. Lower-tier drugs are often associated with lower copayments or coinsurance, making prescription medications more affordable. 


  • Limited Choices: Formulary management, while cost-effective, may limit choices for employees. Some individuals may not find their prescribed medications on the lower tiers, resulting in the need to either switch to alternative medications or potentially face higher costs for their non-preferred brand-name drugs.
  • Potential Disruption: Employees who are already using specific medications may face a transition period if the medication becomes non-preferred. This transition can sometimes be challenging, especially if employees are accustomed to a particular brand and experience concerns about the efficacy and side effects of alternatives.

Preferred Pharmacy Networks


  • Lower Out-of-Pocket Costs: The introduction of preferred pharmacy networks can lead to reduced copayments or coinsurance for employees who choose to use these pharmacies. Employees stand to benefit from lower costs when obtaining their medications, resulting in direct financial savings.
  • Improved Cost Control: Self-insured employers can experience lower costs with preferred pharmacies. This benefits both employers and employees by helping to control healthcare costs. It allows employers to provide competitive benefits and employees to access cost-effective healthcare services.


  • Limited Access: The limitation of access to preferred pharmacies may pose a challenge for some employees. Those living in remote areas or regions with limited network coverage may need to travel further to access these pharmacies, potentially inconveniencing them.
  • Inconvenience: Employees may have established a strong relationship with their current pharmacy, which they trust and are familiar with. The introduction of preferred pharmacy networks might be met with resistance as employees may be reluctant to change their pharmacy, perceiving it as an inconvenience or hassle.

Copayment Adjustments


  • Cost Containment: Copayment adjustments enable employers to manage costs more effectively. This is especially valuable for self-insured employers who aim to strike a balance between providing quality healthcare benefits and controlling expenses. It allows employers to rein in healthcare costs and maintain a sustainable benefits program. If the plan chooses to lower copayments, employees would see a reduction in their medication costs. 
  • Encourage Cost-Consciousness: By adjusting copayments, employers encourage employees to be more conscious of their healthcare spending. Higher copayments for certain services or medications prompt employees to make more cost-conscious choices, such as opting for generic drugs when available or seeking lower-cost alternatives.


  • Higher Out-of-Pocket Expenses: One of the significant drawbacks of copayment adjustments is that they can result in higher out-of-pocket expenses for employees if the copay is increased. While this may be effective in controlling costs, it can be a burden for individuals who rely on specific medications or healthcare services. They may need to allocate more of their budget toward healthcare expenses.
  • Negative Perception: Employees might view increased copayments negatively, feeling that their benefits are being reduced. This perception can lead to dissatisfaction and potential employee morale issues, particularly if they perceive these changes as a decrease in the overall quality of their benefits.

MaxCare: Your Partner in Effective Communication

At MaxCare, we understand the importance of open enrollment success. We are committed to collaborating with our client partners and providing consultative guidance in navigating plan changes. Our goal is to ensure a seamless transition while keeping employees well-informed and prepared for any pharmacy benefit adjustments.

Our services encompass:

  • Customized Communication Plans: We work closely with you to develop tailored communication strategies that meet the unique needs of your workforce.
  • Employee Education: MaxCare offers informative materials, webinars, and personalized support to help employees understand and embrace pharmacy benefit changes.
  • Dedicated Support: Our team is available to answer employee questions and provide assistance throughout the open enrollment period.
  • Transparency and Consultation: We believe in maintaining an open line of communication with our client partners, ensuring that you are aware of any industry trends or changes that may impact your pharmacy benefits.

In summary, open enrollment is a pivotal moment in the annual benefits cycle, offering employees the opportunity to make crucial healthcare decisions. Ensuring that these decisions are well-informed and understood is paramount for employee satisfaction, engagement, and cost savings for self-funded employers. Effective communication during open enrollment is the bridge that connects employees to the benefits that best serve their needs while also promoting cost-effective healthcare utilization.

Self-insured employers have several options to consider when making pharmacy benefit changes during open enrollment. Each option comes with its own set of advantages and disadvantages, and it is essential to carefully evaluate these factors. Effective communication is key to ensuring that employees understand these changes, appreciate the benefits, and navigate any potential challenges. Employers must balance the need for cost containment with the goal of providing quality healthcare benefits, and the right choice will depend on the unique needs and preferences of their workforce. Collaborating with a knowledgeable PBM like MaxCare can help employers make informed decisions and ensure a smooth transition during open enrollment.

More To Explore

Stay Informed with MaxCare

Subscribe to our newsletter for regular updates, industry news, and exclusive content. Stay ahead with expert insights, special offers, and helpful resources.