In today’s complex and competitive healthcare landscape, communication is no longer just a support function—it’s a strategic asset. For small to mid-size Pharmacy Benefit Managers (PBMs), the ability to communicate effectively with patients and pharmacy partners can directly influence member satisfaction, medication adherence, and overall cost management.
In this white paper, PharmaCentra CEO Dan Berman shares how data-informed, and seamlessly integrated communication can become a lever for better outcomes across the board—from reducing administrative burden to enhancing care coordination.
Rethinking Patient Engagement: From Transactional to Transformational
Although healthcare organizations have access to a wide array of communication tools—phone calls, SMS, email, and mobile apps—many still rely on fragmented outreach that fails to engage patients meaningfully. This disjointed experience can lead to confusion, disengagement, and missed opportunities for intervention.
To cut through the noise, PBMs must adopt a patient-centric model that focuses on personalization, consistency, and timeliness. Leveraging engagement data to tailor communications based on a member’s preferences, condition, and treatment journey is essential. When messaging is not just timely but also relevant and empowering, it fosters trust and drives better follow-through.
Modern engagement platforms, including AI-powered contact centers and intelligent messaging systems, now enable this at scale. Automated voice and SMS reminders can go beyond surface-level alerts to reinforce comprehension. Similarly, dynamic email campaigns can be structured to offer educational resources, clarify benefits, and promote next steps—all contributing to improved health outcomes and higher medication adherence.
Optimizing Pharmacy Communication to Reduce Friction
Pharmacies are a critical component in the healthcare network, yet many are constrained by legacy systems and high communication volumes. Patients experience long wait times, unhelpful IVR systems, and misdirected calls—adding unnecessary friction to their journey and straining pharmacy operations.
For PBMs looking to improve both member satisfaction and pharmacy network performance, pharmacy communication must be reimagined. This starts with regular audits of IVR systems and call routing protocols. Intelligent call routing—reviewed and optimized at least biannually—ensures patients are connected to the right resource quickly, improving both efficiency and experience.
Equally crucial is equipping pharmacy teams with up-to-date scripting and support tools. Training should be informed by real-world interactions and adjusted for seasonal trends, prescription volume spikes, or new clinical programs. When pharmacy staff are supported, the entire care continuum benefits.
Moving From Reactive to Proactive Communication Models
Historically, both PBMs and pharmacies have operated reactively—responding to patient inquiries and issues as they arise. But in an era where value-based care is gaining traction, proactive communication can be a game-changer.
Proactive strategies might include notifying members about medication availability, formulary changes, or program enrollment opportunities before they encounter an issue. PBMs that adopt proactive engagement can reduce confusion, enhance member satisfaction, and streamline network operations.
Critically, communication should be a two-way street. Capturing structured feedback from patients, pharmacies, and providers creates a real-time intelligence loop that can identify friction points and guide ongoing process improvement. This isn’t just about solving problems—it’s about preventing them.
The Rise of AI-Driven Engagement: Scale Without Sacrificing Empathy
Artificial intelligence (AI) is rapidly transforming healthcare communication. For PBMs, AI can help scale operations without compromising quality—handling routine inquiries, triaging benefit questions, sending appointment or refill reminders, and even screening members for clinical program eligibility.
This hybrid model—where AI manages predictable workflows and live agents focus on complex or sensitive interactions—boosts both operational efficiency and member experience. During high-volume periods, it ensures consistent messaging and regulatory compliance, while also alleviating burnout among contact center staff.
Yet, human oversight remains critical. AI should enhance, not replace, the empathetic conversations that build trust, address nuanced care needs, and guide members toward better health decisions.
Final Thoughts: Communication as a Catalyst for Value
For PBMs aiming to optimize costs, improve adherence, and deliver a superior member experience, modernized communication strategies are essential. Thoughtful, tech-enabled outreach helps reduce administrative burden, improve network performance, and ultimately support better outcomes for members.
Effective communication isn’t a checkbox—it’s the connective tissue that powers everything from patient engagement to operational excellence. For small and mid-size PBMs, it represents an opportunity to differentiate, deliver value, and drive loyalty in an increasingly competitive marketplace.
About the Author:
Dan Berman is the CEO of PharmaCentra and brings over 35 years of experience in the contact center industry, with a strong focus on healthcare, quality assurance, and patient engagement. PharmaCentra is at the forefront of improving communication between patients, pharmacies, providers, and healthcare organizations—helping drive better outcomes across the healthcare landscape.
