There are few things scarier than urgently needing a medication, just at a time when everything is about to be closed.

That’s just what happened to one member who suffers from heart problems. A mistake in enrollment information received by HealthPartners had thrown a wrench in the works. According to Betsy Ravis, Senior Manager, Health Plan Pharmacy Customer Experience at HealthPartners, “If we'd waited for the administrative paper work to go through, he would have been without his heart medications over the Thanksgiving holiday.”

Luckily, they didn’t wait, and a team of dedicated Pharmacy Navigators sprang into action to make sure that a stressed-out member could have peace of mind over the holiday.

That’s exactly the kind of help Betsy Ravis envisaged when, seven years ago, as a fresh pharmacy programs manager at HealthPartners, she launched the Pharmacy Navigator program.

Kind, expert help making sense of medications

“We wanted pharmacy navigators to be an extra line of support,” says Ravis. “There are a lot of complicated pharmacy details that are not intuitive or easy to grasp. Our navigators help members understand their pharmacy benefits and solve complex, frustrating prescription drug-related issues that can span everything from costs, generic vs. brand name drugs, claims, and medication status changes.”

It’s a unique part of HealthPartners’ pharmacy health plan services, and one Ravis adds that she’s not been able to find elsewhere.

Because callers are often emotional and possibly at their wit’s end, it's key that navigators are kind, good listeners, and great problem solvers.

“Mapping out the process of how we help our members is vital because we could steer them in the wrong direction easily otherwise,” relays Ravis. “We are very particular about who we hire because it takes a special person.”

Helping employers keep employees in the picture

Pharmacy navigators can support employers by creating targeted email or letter campaigns that tell health plan members about any prescription drug plan changes coming up. They provide direct contact information to answer questions and offer further guidance. And, they work closely with members to ensure they understand their treatment, medication, and options when they receive a new diagnosis.

Trouble-shooting to help members

Some of the most stressful situations they help manage are when an issue is not discovered until a member is right in the pharmacy, trying to pick up a prescription drug. Perhaps the medication is a little higher priced than average, a provider failed to add a member’s prior authorization or a claim is being rejected for no apparent reason.

That’s what happened in the Thanksgiving story in the introduction.  Although the member had prescription drug coverage, he was alarmed to find that he couldn’t pick up his heart medication because his pharmacy claim was rejecting. Because of the fast-advancing holiday weekend, there was a real possibility that he would be without his life-saving prescription.

His case manager called HealthPartners and pharmacy navigators Kerry Crill and Kirsten Pengelly immediately dived into the computer systems to understand why the claim was being rejected.

Determined pharmacy problem solvers

They partnered with colleagues across various teams, says Ravis. “There were probably 11 people and six different departments involved to get this member his heart medications before Thanksgiving.”

Investigations uncovered a rare example of an enrollment error.

“It’s exactly that kind of situation where the cause is unclear at first, and pharmacy navigators have to be like detectives, asking questions and working with all the right people to gather the right information."

"Even armed, as they are, with all the available tools and resources to solve problems like this,  it would usually take several days, maybe even into the next week to figure out what’s going on,” says Ravis.

Beating the clock to get the meds on time

But the clock was ticking. In the next few hours, Pengelly made a reassuring call to the member, corrected the wrongly-assigned eligibility file (no simple matter), took action to ensure that the claim would go through, and confirmed that the pharmacy was ready for him to pick up the medications.

“We were able to fix the problem within a day, working across different departments,” adds Pengelly. “A lot of collaboration and investigation goes into making sense of these complex issues, and it’s because of that we can resolve them so quickly.”

If they had had to follow the normal process to make the enrollment change, the member would have had a very different Thanksgiving holiday, reveals Pengelly.

She's pretty sure he had no idea of all that was going on behind the scenes. "All he knew was that we said we would take care of it. And we did.”