Helping Union Members Make the Most of Their Prescription Benefits

Member Education: Helping Union Members Make the Most of Their Prescription Benefits

When it comes to health benefit cost trends, prescription drugs continue to show the highest projected rate of increase for 2026 at 11%. Among the top cost drivers is significant growth in specialty drug utilization.

While many aspects of these rising drug prices are outside of funds’ control, funds have the power to influence members’ behavior at the point of care – redirecting members to the most effective, lowest-cost drugs. This approach requires comprehensive member education on topics like formulary adherence, mail-order versus retail channels, prior authorization compliance, and price-comparison shopping.

For example, a member might pay $300 out-of-pocket for a prescription that could have cost only $35 via mail order. Funds can take advantage of these cost-saving opportunities by working closely with their pharmacy benefits provider to ensure that members know how to get the best care at the best price.

Communication Strategies That Work

Prescription drug access and cost-sharing can be confusing for members, especially with regards to brand versus generic medications or specialty drugs versus biosimilars. Members may also become frustrated when dealing with unexpected delays due to prior authorization or step therapy.

To help members make the most of their prescription benefits, funds should partner with a pharmacy benefits provider that offers:

• Frequent, consistent, and clear member communication
• A multi-channel approach to messaging (push alerts from the member portal, reminders via SMS, etc.)
• An Interactive Voice Response system (IVR) or AI assistant that members can contact 24 hours a day, seven days a week.
• One-page mailers and steward briefings to communicate more complex plan details or changes

Pharmacy benefits providers should have a formulary lookup easily accessible on the member portal, as well as explainers in languages such as Spanish, Polish, and ASL. Sharing spotlight stories of members who have saved time and money by switching to generic medications can be another way to demonstrate everyday cost savings. Simple nudges, such as defaulting members into 90-day prescription fills unless they opt out, can also drive successful behavioral changes.

Partnering with a PBO

A pharmacy benefits optimizer, or (PBO) is a key partner for funds looking to ramp up member education and control rising costs.

But to understand the role of a PBO, it’s first important to learn about pharmacy benefit managers (PBMs). A PBM manages prescription drug benefits for funds, insurers, and employers. They negotiate drug prices, manage pharmacy networks, create and maintain formularies, and more. As such, they have the power to influence drug pricing, coverage, and member access. While a frequent partner for funds, PBMs often have misaligned financial incentives – such as receiving generous rebates in exchange for giving a drug preferred placement on their formularies.

A PBO, on the other hand, provides payer advocacy and solutions unlike other types of pharmacy benefits partners. A PBO acts independently of other key players in the industry to serve in the best interests of funds and their members. Among other capabilities, a PBO provides competitive pharmacy contract pricing and drug rebates, clinical management programs to ensure appropriate drug utilization, and direct member support services.

A PBO like RxBenefits can help strategically educate members and direct them toward cost-effective solutions. For example, RxBenefits offers a dedicated member service team for one-on-one assistance with challenges relating to prior authorization or denied claims. A PBO can also help members find and apply for alternative funding sources for high-cost specialty drugs or even access FDA-equivalent medications (that still meet appropriate quality standards) through International Drug Sourcing.

Manage Costs Without Sacrificing Benefits

By turning dense plan information into succinct, accessible language – and delivering it through channels members already trust – funds can keep members informed and proactively engaged in their own care. When members are empowered to make the most of their prescription coverage, their choices help funds control rising costs without sacrificing rich health benefits.

For funds, every dollar saved on unnecessary pharmacy spend protects bargaining power for future benefit and wage increases. Investing in strategic education and communication is key to ensuring that pharmacy plans remain sustainable for union members for many years to come.

Meta Title: Helping Union Members Make the Most of Their Prescription Benefits | RxBenefits
Meta Description: Learn how investing in strategic education and communication is key to ensuring that members receive the best care at the best price.