Evaluating a pharmacy benefit manager (PBM) is incredibly daunting. There's a whole host of considerations that go into making the decision. Yet, when multi-million-dollar budgets are on the line, member support often gets weighed last.

Not putting proper emphasis on the member experience can have serious consequences down the line. Subpar member support from your PBM can lead to confused members and a steady stream of escalations, all of which land on your human resources (HR) team to address.

Luckily, you can judge the quality of PBM member support against clear criteria, the same way you review rebate agreements and pricing terms. By establishing clear criteria during your request for proposal (RFP) process, you can better judge whether a potential PBM partner will curb escalations, protect the member experience, and ease the work load on your internal benefits team.

What PBM Member Support Includes

PBM member support is the set of services and resources a PBM provides to help members understand their pharmacy benefits, navigate coverage questions, resolve issues, and access medications. A strong member support function will leverage:

• A dedicated team of on-shore employees, including call center representatives, who guide members through questions, coordinate next steps, and conduct outreach when escalations arise

• A foundation of clinical expertise that's guided by licensed pharmacists who review cases and provide guidance when a member's situation requires clinical judgment.

• A suite of technology designed to streamline the entire support process and aid both members and support staff, not pass decisioning off entirely to machines. It can also encompass digital tools, like member portals, that surface prescription status, prior authorization updates, and savings opportunities so members can find information quickly.

By establishing the clear areas of responsibility within member support, you can better measure whether a PBM is competent in each area and if they have the staff resources to support them at scale. Leading member service provided by a modern PBM will provide white-glove service to all your members and have the data to back their service claims up.

The Impact of Member Support

Across all benefit types, poor member support drives up costs and hurts retention. Given they are non-elective, pharmacy benefits are particularly misunderstood by members. One survey of full-time employees reported that member understanding of pharmacy benefits was low to moderate at best.

This misunderstanding can manifest at pharmacy counter confusion and inflated medication costs that cause some walk away without filling their prescriptions. According to GoodRx, 27% of Americans walk away from a prescription they cannot afford. Oftentimes, there are more affordable options available to the member, they're just unable to easily access it through their benefit manager.

For benefits leaders, every abandoned prescription or unresolved prior authorization creates downstream effects: employees who are frustrated, less healthy, and more likely to escalate to HR. Strong member support reduces that burden by helping employees navigate their benefits before problems compound. The quality of support your employees receive is a plan-performance issue, not just a service detail.

How Employers Should Evaluate PBM Member Support

The PBMs that offer the highest stand of member support go beyond 'transactional' style support. Truly modern, 'white glove service' PBMs respond with empathy, offer proactive guidance, and connect members to clinically appropriate and cost-saving resources. For something so 'qualitative', how do you quantify that during an RFP? It starts by pushing a potential PBM on how they measure support success and how it's accountable to those results.

Use the criteria below in a request for proposal (RFP) or at renewal, and ask for the data behind area:

• Dedicated, On-Shore Support: Ask which teams handle member questions, clinical review, and escalations and the member to staff ratio. In addition, find out what percent (ideally 100%) of staff is based in US time zones to match the schedule of your employees. If a large percent of your staff's native language isn't English, ensure the PBM has staff to accommodate bi-lingual support.

• Average Member Wait Time: Request average phone, chat, and email response times, since slow access is where member frustration starts.

• Member Satisfaction Tracking: Ask whether the PBM measures member satisfaction and effort, and how it acts on the results.

• Multichannel Access: Confirm that members can reach support by phone, chat, and a self-service portal.

• Member Experience Reporting: Require reporting that includes member experience metrics alongside cost and rebate figures.

Request the actual numbers behind these claims, such as average wait times and member satisfaction scores, and ask how each one is measured. For a fuller checklist, see guidance on the key criteria for PBM member service and how to evaluate a PBM.

How SmithRx Approaches Member Support

At SmithRx, delivering leading member support is a core component of our mission to improve healthcare. SmithRx combines empathetic human support, proactive communication, clinical expertise, and digital tools so members can understand and get true value from their pharmacy benefits. Their member-support agents and Patient Advocates guide members, coordinate next steps, and conduct outreach; our licensed pharmacists review clinical cases; and the SmithRx Member Portal gives members easy access to their case status, prescription options, and benefits information.

What's more, SmithRx holds their member support to measurable standards. In 2025, members rated their experience 4.5 out of 5 on the member satisfaction (MSAT) survey, and internal reporting shows members waited less than 21 seconds on average to reach a support agent. You can read more on how empathy at scale shapes member support at SmithRx.

Frequently Asked Questions

Benefits leaders often raise these questions when comparing PBMs on member support.

What is the difference between member support and account support?

Account support serves the employer and broker through a dedicated account team, while member support serves the employees who use the pharmacy benefit.

How can employers evaluate a PBM's member support during an RFP?

Ask for defined support roles, average response and wait times, member satisfaction and effort tracking, and reporting that includes member-experience metrics. These details let you compare PBMs on evidence rather than marketing claims.

Do the largest PBMs provide the best member support?

Market size does not determine service quality. A PBM's support quality depends on response times, proactive outreach, clinical expertise, and how effectively support connects members to help. Benefits leaders should evaluate support capabilities directly rather than assuming that scale guarantees a strong member experience.

Leading member support is service quality that employers can define, measure, and evaluate. It combines empathetic human teams, clinical expertise, and digital tools, all delivered through a transparent PBM model aligned with employer and member goals. Benefits leaders who build support criteria into their PBM selection process can protect employee experience while controlling pharmacy costs.

Want to learn more about SmithRx's, 100% in-house, on-shore leading member support teams? Reach out to our team today.