Best Practices for Implementing BPOs in Pharmacy Benefits Management (PBM)

Pharmacy benefits management (PBM) is a key process in the healthcare field. There are a variety of options when it comes to PBM and ensuring that you choose the right one is essential in ensuring that all parties involved receive the best services possible.

In this article, we’ll discuss outsourcing PBM and the benefits that can come from it. Let’s get started and dive deep into some of the reasons why you should consider outsourcing pharmacy benefits management.

Outsourcing Benefits

Understanding the benefits of outsourcing pharmacy benefits management can help you decide if it’s the right choice for your business. Let’s go over some of the most notable benefits to consider.

Cost Savings

Did you know that outsourcing can actually save you money? Outsourcing can save your team time and reduce potential errors, making it a very budget-friendly option. By outsourcing PBM, you can save money and increase efficiency.

When you outsource PBM, you'll gain access to a team of specialized workers with experience in this area. This means that you'll be increasing efficiency and ensuring that everything is done promptly and appropriately.
Specialized Expertise
As we mentioned, outsourcing means gaining access to a team with extensive experience in PBM. This will save you time and money, plus it can provide you with the peace of mind that comes from entrusting business practices to a team of exceptional workers who understand what it takes to succeed.

Outsourcing Challenges

While outsourcing can be an exceptional option for many businesses, that doesn't mean there aren't some challenges it can present. Being aware of potential challenges is important so that you can have an accurate understanding of what exactly outsourcing this area of your business could mean.


Communication is one of the biggest challenges that can come from outsourcing PBM. Communication can depend on various factors, including how your in-house team is involved, where your outsourced staff is located, and what tasks you're outsourcing.

If you're concerned about the communication factor of outsourcing, then it's best to have clear guidelines before you begin. Having expectations in writing can ensure that everyone is on the same page and that you get the results you're looking for.

In-House Integration
It is possible that in-house teams can struggle with the integration process often required from outsourcing. While this can be true, it's not always the case. There are a variety of different things that you can do to make the integration process smooth, including opening communication channels, setting clear guidelines, and making sure that everybody knows what their role is.

Defining Goals and Objectives for Outsourcing PBM

If you're considering outsourcing PBM, then you must have goals and objectives in place. This is a good way to be sure that you're setting clear guidelines and understanding what exactly you want to get from outsourcing.

There are a few different goals that are common for companies that are going to be outsourcing PBM.

Process Management

From inbound refill requests to customer satisfaction surveys, many different processes need to be coordinated. The good news is that outsourcing can be an exceptional way to make sure that these processes are not only taken care of, but that they're being done in an efficient, structured fashion.


Physician and pharmacy coordination can be complicated, but it's an essential component of PBM. Outsourcing this area can relieve stress from your in-house team and ensure that coordination is done correctly. Various factors need to be considered regarding communication and coordination, so consider if outsourcing this area could be the right choice for your business.

Technology Utilization

One of the most common goals many businesses have is utilizing technology to its full capacity. This is one of the areas where outsourcing can come in, as your new staff will not only understand relevant technology but be able to make suggestions about what software makes the most sense for your specific business processes.

Achieving Goals

There are so many different ways that outsourcing PBM can help your organization achieve its business goals. Not only will you have a staff dedicated to specific tasks, but your in-house team can also focus on other specialized areas. Freeing up your current staff to focus on things they specialize in can increase your revenue and productivity.

Evaluating KPIs

Creating specific key performance indicators (KPIs) is essential when it comes to outsourcing. Developing KPIs that make sense for your business will help you measure success and ensure a reasonable ROI.

When creating KPIs, it's important to consider small and large details. Consider asking yourself the following questions:
  • How would you like outsourcing to increase your revenue?
  • What impact do you want outsourcing to have on your current staff?
  • How are you measuring customer satisfaction?
  • What ROI do you want to achieve?
Answering these questions is a great way to ensure everyone is on the same page bout what you want from outsourcing.

Key Selection Criteria the Right BPO Partner

When it comes to outsourcing, not all BPO partners are the same. Carefully evaluating partners is the best way to ensure you're making the right choice and selecting a partner that will help you accomplish your business goals.

There are a few different criteria that are essential to consider when it comes to selecting the
right BPO partner. Thinking about the following factors is a great way to be sure that you're on
the right track when it comes to finding a partner that makes sense for your business.


We've already discussed the importance of communication. Asking potential partners about their communication standards is a good way to understand their priorities and ensure that your expectations would be met if you chose them.

Understanding how a BPO partner will communicate with you is important, but it's also essential to understand how they with others such as physicians and pharmacies. This level of coordination is often essential to PBM, so ensure you understand their communication philosophy and strategies.

When it comes to communication, location is one of the most important factors to consider. If you’re going to be working with a partner whose staff is in a different timezone, then that could potentially create some communication problems. Having an open and honest conversation about this is a good way to be sure that your communication standards would be prioritized.
Scalability and Adaptability
Understanding a partner's dedication to scalability is a good way to learn more about their priorities and how they respond to various situations. Being able to scale your partner's services and demand rises and falls is important so that you can be sure you'll receive exactly the right level of support.

Warning Signs

There are a few different red flags that you should watch out for if you’re in the process of evaluating potential outsourcing partners.

Questions and Answers

If an outsourcing partner isn't open to you asking them questions, they might not be the right choice. On the other hand, if a partner can't answer your questions, consider other options. You should get detailed, extensive answers to all your questions to ensure you're selecting the right partner.

Testimonials and Case Studies

Most outsourcing partners can provide you with testimonials and case studies. If an outsourcing partner can't prove past success, they might not be the right choice for your business. Being able to look at past reviews is important, so don't be afraid to ask for sales collateral.

When looking at past testimonials and case studies, be sure to request some that are specific to PBM. Many BPO providers work in multiple fields, so seeing results from PBM projects is important.

Problem Solving
Working with an outsourcing partner means that problem solving will be involved. If a partner isn't open to problem solving and discussing potential issues, they're likely not the right option. Collaboration is essential to outsourcing, so don't be afraid to ask how a partner would deal with potential situations.

Establishing Effective Communication Channels and Performance Metrics

Setting clear communication standards is important, but it's also essential to consider what software and technology you'll use for communication. Having open communication channels for both your outsourced and in-house staff is a good way to ensure that everyone is on the same page and has the resources they need to succeed.

Performance Metrics

We briefly mentioned performance metrics previously, but let’s return to them.

Creating individualized performance metrics is the best way to ensure you understand the benefits of outsourcing. Whether you're looking to increase revenue, improve communication, or get better customer reviews, having the right performance metrics in place is important.

Performance Issues

Performance issues are a reality that must be faced when it comes to outsourcing. Performance issues can arise at any point, so planning how they'll be dealt with is important.

Speaking with a potential partner about how they would handle performance issues is an excellent way to understand their methods and priorities, so don't be afraid to have a solid plan for when problems arise.

Fostering a Collaborative Relationship Between the BPO and In-House Teams

We’ve briefly touched on the relationship between BPO and in-house teams, but let’s dive deeper now.

Your two teams' relationship can significantly impact business processes and outcomes, so it's important to consider. Fostering a collaborative relationship can encourage success, communication, and unity, so it should be considered and worked towards.

Below are a few things you can do to encourage collaboration and ensure that the transition process to outsourcing goes as smoothly as possible.

Clear Responsibility Outlines

Ensuring everyone has a clear understanding of their responsibilities will reduce miscommunications and save people time. Having multiple people work on the same task isn't ideal, so spending time ensuring everyone understands their roles will eliminate confusion and increase efficiency.

It may take time for everyone to understand where they fit into the new team dynamic but don't become discouraged. Providing a resolute stance, consistency, and clarity will make the transition as smooth as possible.

Effectively Distributing Resources

Along with establishing collaboration and communication comes ensuring that your BPO partner has the information and resources needed to be successful. Doing this will reduce the need for constant communication and ensure that your partner is as self-sufficient as possible.

Before committing to working with a partner, be sure to ask them what resources they will need. This can help you prepare and ensure you're on the right track. If there are resources they need that you haven't developed, consider if it's worth the time investment (it very well might be).

Communication Channels

Properly establishing comprehensive communication channels will ensure everyone has the resources to collaborate effectively. It's essential to consider communication and prioritize the right software, especially if you're working with individuals in different time zones.


Giving timely and appropriate feedback can help your BPO partner improve their services and provide you with quality work. Setting clear and direct methods for feedback is the best way to be sure that everyone's working together towards common goals and that adjustments are made when necessary.

Managing Data Privacy and Security

One of the biggest concerns many people have when outsourcing is managing data privacy and security. This is undoubtedly important in protecting your business and remaining within regulations and guidelines.

Putting clear privacy and security measures in place is essential, which can mean utilizing the right software and developing secure practices. Doing this will ensure that your BPO partner is protecting your organization and not putting you at risk for a breach or leak.

Auditing Security Measures

Most BPO partners will already have security measures in place when you're interviewing them. Asking them detailed questions about these measures is a good way to understand their dedication to privacy and security, so don't be afraid to get the answers you need to make an informed decision.

Ensuring Regulatory Compliance

Regulatory compliance is an important piece of this discussion, especially concerning PBM. The healthcare sector is extremely specific about regulations; failing to conform to them can put your business at risk.

Both organizations and their BPO partners need to have regulatory compliance standards to stay within their legal rights and provide the best services to their customers.

BPO partners should clearly understand HIPAA, HITRUST, PCI and AICPA. Ensuring that a potential partner has a deep grasp of these guidelines can provide you with peace of mind and assurance that your business operates within legal regulations.

Asking potential providers for their healthcare compliance plan is an excellent way to understand what practices they have in place for maintaining compliance. Carefully detailing this plan and asking any questions you may have will help you learn more about the partner and their dedication to regulations.

Healthcare compliance software can play an important role in ensuring that your potential partner is on the right track and maintaining a high standard of compliance. Utilizing the right software is a good way to ensure you're checking all the required boxes and remaining within your legal rights.

If a potential partner cannot provide you with information about their regulatory compliance standards, then it may be time to move on with your search. This is an essential component of maintaining your business's integrity and ensuring that you remain protected.

Effectively Outsourcing PBM

When it comes to outsourcing PBM, there are many different options. The way that you go about outsourcing can significantly impact the results you achieve, so it’s essential to make sure that you follow best practices and set your team up for success.

In summary, here are some things to consider when you're at the beginning of the outsourcing process:

  • Develop clear goals and objectives
  • Carefully select and evaluate BPO partners
  • Establish consistent communication and thoughtful performance metrics
  • Implement data privacy and security measures
  • Prioritize regulatory compliance
  • Foster collaboration between your BPO and in-house teams

By doing the things above, you can improve the efficiency and cost-effectiveness of your PBM operations.

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