Key Takeaways

• Formularies change more often than many clients assume, sometimes multiple times a year, so regular checks are necessary to avoid unexpected costs.

• Teaching clients a quick self-check empowers them to monitor changes and builds long-term trust in your role as their advisor.

Why Formularies Shift More Often Than Clients Think

Many clients believe that formularies only change once a year, but the reality is more dynamic. Formularies are living documents that reflect the most recent decisions by insurers, pharmacy benefit managers, and regulatory requirements. Updates can occur quarterly, monthly, or even sooner depending on negotiations and safety alerts. This pace of change is especially true in 2025 as prescription drug markets evolve rapidly.

For you as an agent, explaining the frequency of these changes helps clients appreciate why their medication costs or coverage can suddenly look different even within the same calendar year. This sets the stage for offering them a tool they can use independently.

The Consequences of Not Checking Regularly

If clients assume that last year’s coverage is identical this year, they can easily run into unpleasant surprises:

• A previously covered medication may now require prior authorization.

• Tier levels can change, raising out-of-pocket costs.

• A drug can be completely removed, forcing a switch to alternatives.

• Quantity limits or step therapy rules can appear unexpectedly.

By showing clients how to spot these shifts early, you prevent frustration and maintain your reputation as someone who anticipates problems rather than reacting to them.

Explaining the Timeline of Changes

To give clients clarity, outline the common timelines of formulary updates:

1. Annual reset: Every January, formularies often introduce the most significant updates. Clients should expect new cost structures and coverage tiers at this time.

2. Quarterly adjustments: Reviews in April, July, and October often bring smaller but still impactful changes.

3. Mid-year safety or policy updates: If a drug receives new safety warnings or generics enter the market, plans can update coverage outside of their regular cycle.

Highlighting these three key checkpoints helps clients understand that formulary reviews are not a once-a-year event.

Teaching the Quick Self-Check Process

Your clients do not need to memorize every detail about formulary structures, but they do need a reliable, repeatable method to check for updates. Here is a simple self-check you can teach them:

1. Locate the plan’s formulary online: Encourage them to bookmark the official formulary link or keep it in an easy-to-access folder.

2. Search for their medication by name: Most formularies have a search function. This ensures accuracy compared to scanning lengthy lists.

3. Check the tier and restrictions: Remind them to look for tier placement, prior authorization requirements, quantity limits, and step therapy notes.

4. Compare to the last visit: If something looks different from their last appointment, they should write it down and bring it up at their next doctor or pharmacy visit.

5. Repeat quarterly: Reinforce that they should do this every three months to stay ahead of changes.

This five-step routine turns a complex task into a short exercise clients can manage without feeling overwhelmed.

The Role You Play in Reinforcing the Self-Check

Even when clients know how to self-check, they need reminders. This is where your guidance becomes invaluable:

• Send a quarterly reminder email encouraging them to review their medications.

• Include a brief checklist or template so they can track results.

• Offer to review findings during their annual plan check-up or mid-year consultations.

By providing these touchpoints, you reinforce your role as an ongoing partner in their healthcare decisions rather than a one-time enrollment assistant.

Building Confidence Through Simplified Explanations

Many clients are intimidated by the idea of navigating a formulary. To reduce that anxiety, frame it as no different than checking a bank balance or reviewing a credit card statement. Both require quick log-ins and simple comparisons. When you normalize the activity, clients feel less hesitant to try it.

Using familiar analogies also helps you communicate that self-checking is routine rather than burdensome. The more approachable you make it, the more likely clients will adopt the habit.

Handling Client Pushback

Some clients may argue that they do not have time or that they trust their provider to manage medication updates. Here’s how you can respond:

• Time concern: Stress that the self-check takes only a few minutes once they are set up with the link.

• Trust in provider: Explain that while doctors do monitor medications, they may not know the cost-sharing details of every plan. A quick self-check bridges this gap.

• Frustration with complexity: Acknowledge that the system is confusing but reinforce that small proactive steps now prevent larger issues later.

Positioning the self-check as an easy insurance policy against surprises helps clients see the value.

Using the Self-Check to Open Deeper Conversations

Each time you guide clients to review their formulary, you create an opportunity to discuss other aspects of their coverage. For example:

• Are they aware of preventive services included with no additional cost?

• Have they reviewed coverage for dental, vision, or hearing in case they need those services?

• Do they know their plan’s annual out-of-pocket maximum and how drug costs affect it?

Linking the formulary self-check to bigger conversations about overall coverage helps strengthen your role as a comprehensive resource.

Encouraging Clients to Document Their Results

Another way to help clients is to provide a simple worksheet where they can jot down:

• The name of each medication.

• The formulary tier it is listed under.

• Any restrictions like prior authorization or step therapy.

• Notes about cost differences compared to the last review.

When clients keep this running record, they have an easy reference for doctor visits or when discussing coverage concerns with you. It also reinforces the habit of monitoring regularly.

Reinforcing the Annual Open Enrollment Connection

Self-checks throughout the year prepare clients for the most important window: the annual enrollment period from October 15 to December 7. If they have tracked changes, they are better positioned to decide whether to stay with their current plan or switch to a new one.

By connecting quarterly checks to the annual decision-making period, you show clients that small habits throughout the year add up to big advantages when it matters most.

Why Clients Appreciate This Strategy

When you teach clients this method, you accomplish more than saving them money. You demonstrate that you:

• Anticipate problems before they arise.

• Give them tools they can control themselves.

• Stay engaged throughout the year, not just at enrollment.

These qualities translate into higher retention and stronger referrals, both of which benefit your business long-term.

Staying Ahead With BedrockMD

Helping clients understand and act on formulary changes is just one part of building trust. At BedrockMD, we equip you with the tools, training, and resources to keep clients informed and supported year-round. By joining us, you gain access to proven strategies that make you the advisor clients turn to again and again. Sign up today and let us help you strengthen every client conversation.