When PBM Portals Work for Everyone: A Member-First Transformation

How to rethink your PBM Member Portal and why it impacts your bottom line.

Your members might know your PBM offers a portal, they simply don't use it.

The data backs that up across the industry. We’ve seen that less than 10% of eligible members register for most PBM portals. Even those who do register often abandon their tasks halfway through, frustrated by confusing workflows and mobile experiences that feel like desktop afterthoughts.

Meanwhile, your call centers are fielding hundreds of thousands of routine inquiries about drug costs, prior authorization status, and benefit details. All of which are questions that should be answerable online.

The fact is, many PBM portals were designed to manage transactions, claims, prior auths, and eligibility checks. What they weren’t designed for? Member questions such as:

"How much will my medication cost?"
"Why was my prescription denied?"
"When can I refill?"

That gap between system logic and human need, combined with the latest regulatory transparency requirements and legacy system constraints, mean that member portals have gone from being a tool meant for self-service to another problem for your teams to solve.

But what happens when you flip the equation and design portals for the real people who use them, not just for the systems behind them?

The answer is that it can transform more than just user experience. It reshapes operational costs, client satisfaction, and competitive positioning in ways that directly impact your bottom line.

The Real Cost of Portal Problems

Your member portal sits at the center of a complex web of operational costs that most PBMs dramatically underestimate. While you track the obvious expenses of system maintenance and support, a more substantial threat quietly erodes your competitive position, and the costs cascade across your entire operation.

FOR MEMBERS

Confusing flows, outdated mobile design, and unclear benefit details turn what should be a simple task into a source of frustration. Single-digit registration rates tell only part of the story. Members who do register face:

Navigation confusion, forcing members to hunt for basic information like prior authorization status
Poor mobile experiences, creating smartphone user friction
Missing self-service options, requiring members to call for routine tasks that would take seconds to resolve online
Unclear benefit information, leading to less-informed decisions at the pharmacy counter, driving up overall costs

The result? Members lose trust in your digital capabilities, abandon self-service, and call support instead. But it’s not just members who suffer - your support team, health plan clients, and even the pharmacists who connect members to medications are all impacted.

FOR PHARMACISTS

Pharmacists depend on real-time prior authorization updates and clear benefit information to guide patient conversations. When prior authorization status is buried or confusing, prescriptions stall.

Patients facing delays or confusion about coverage often abandon prescriptions entirely. Each abandoned prescription represents lost revenue for both you and the pharmacy, as well as missed health outcomes for the patient.

FOR HEALTH PLAN CLIENTS

Poor digital experiences translate directly to client dissatisfaction. When employer groups compare PBM options, the quality of the member portal increasingly factors into their evaluations. Market leaders deliver seamless member experiences, so without one, you’re reinforcing a perception that your organization is lagging behind.

FOR SUPPORT TEAMS

Where is the cost more visible than in your call center? High call volumes for basic questions tie up agents with issues that should be handled in two clicks online.

Your support teams spend their time answering questions that a modern portal could handle automatically, consuming resources that could be better spent on complex member needs.

THE ONGOING TOLL

These costs don't exist in isolation. As time goes on, they multiply and reinforce each other. Negative member experiences drive call volume, which increases operational costs, which reduces resources available for improvements, which perpetuates poor experiences.

The math is sobering and your legacy portal’s abilities are a business constraint masquerading as a maintenance issue. Meanwhile, the opportunity cost of delaying client enhancements and its competitive disadvantage grows larger each quarter.

It’s More Than Just A Technology Problem - But There’s A Smart Solution

The good news is that these problems with legacy member portals aren’t permanent. Nor do they require ripping out core systems or lengthy waits for ROI. It actually starts by rethinking how humans interact with pharmacy benefits.

We know this approach works because we’ve used it working with numerous PBMs, including one covering 25+ million members.

Before redesigning interfaces, we work with PBMs to map their actual user journeys across all touchpoints. Since most legacy PBM portals weren’t built with the full ecosystem in mind, it’s necessary to understand the ways that each group interacts with the system.

Mapping the Real User Ecosystem

Members expect a modern user experience.

They need more than claims lookup. Members want intuitive navigation, real-time information, and mobile-first design. They seek cost estimates before pharmacy visits, coverage details, and clear explanations when medications require prior authorization.

Instead, they’re getting interfaces that require multiple login attempts, display inaccurate accumulator balances, and force them to call support for routine inquiries. The portal treats them like data entry clerks when they need guided experiences.

Health Plan Clients require transparency tools

They want portals that make their members successful, not frustrated. Employers and Plan Sponsors want transparent dashboards and real-time analytics that show utilization patterns and spending.

Legacy portals often provide limited reporting capabilities, forcing benefits administrators to request custom reports and wait for manual data pulls.

Pharmacists need real-time visibility

Pharmacists prefer point-of-sale integration that shows real-time benefit information, member eligibility. and prior auth status. This information along with alternative options allows them to counsel patients effectively.

When member portals only share static information that requires pharmacy staff spend time on manual verification calls and prior auth clarifications, it slows down the entire process.

Support Teams want self-service tools

Internal support teams bear the brunt of the impact through call volume spikes when portals don’t provide easily accessible information. Calls about drug costs, benefit questions, and prior authorization status are all things that could be answered by a truly self-service member portal.

The Interconnected Nature of Portal Problems

We regularly see PBMs not realize just how intertwined their user experience problems are until it’s made clear during user mapping. How something like a confusing member interface generates support calls, which strains client relationships, which then creates pressure for quick fixes that often makes usability worse.

But their experiences aren’t isolated and those elements are applicable to most legacy PBM member portals. However, the interconnected nature of portal problems means that solving for each one has a ripple effect across your organization.

What Member-First Portals Look Like

When PBMs rebuild their member portals around real user needs, the transformation goes beyond cosmetic changes. Rather than layering new features onto existing frameworks, market-leading PBMs map member journeys from prescription pickup to benefit questions.

When technology decisions flow from journey insights, the result is an intuitive, modern digital experience that members actually use. In the case of the PBMs we’ve recently with, after mapping their user groups, their redesigned experience have delivered:

Guided, Personalized Digital Flows

Instead of generic dashboards, personalized entry points are based on member plan type and recent activity.
Real-time prompts eliminate confusion and members are guided through clear pathways for common tasks like refills, cost comparisons, and prior authorization requirements.

Mobile-First Design

Responsive layouts work seamlessly across devices, and document uploads are reliable regardless of camera qualities and file types.
Touch-friendly interfaces are optimized for one-handed phone use, with the most common tasks accessible within two taps.
Progressive web app functionality for app-like performance without app store friction.

Real-Time Status Updates

Live claim processing status, prior authorization progress tracking, and benefit accumulator information are provided

Members see actual information, not generic "processing" messages.
Claims statuses are updated immediately, not hours or days later

Contextual Guidance

Smart prompts that surface relevant information at decision points.
If a medication requires prior authorization, the portal explains why and shows next steps immediately.

Unified Information Architecture

Members, pharmacists, and providers see the same real-time status, reducing friction that creates member frustration

Gives pharmacists access to same cost estimates and benefit details members see at home.

Draws all digital touchpoints from same real-time data sources with coordinated data architecture, improving trust and reducing duplication of effort.

Built-In Compliance

Automated transparency reporting and regulatory guardrails are embedded in user workflows.

Audit trails capture required information automatically as members complete routine tasks.
Compliance becomes invisible infrastructure, not additional complexity.

Security protocols protect data without creating unnecessary authentication hurdles.

When all these elements work together, the member experience is fundamentally transformed. And it starts with understanding real user needs

When Self-Service Actually Works

Applying this member-first framework has delivered measurable improvements for PBMs we’ve worked with:

Member portal adoption rates have jumped within months of launch.
Call center volume for routine benefit inquiries have dropped as members find answers online.
Client satisfaction scores increased.
Prior authorization completion time decreased thanks to clearer member guidance.

More than just looking better, this market-leading, user-focused PBM portal actually works better for everyone. When PBMs commit to journey mapping first, the resulting portals reduce costs, increase adoption rates, strengthen client confidence, and reinforce the PBM as a digital leader.

The Four Steps to This Member-First Approach

Success came from process changes, not just technology upgrades. By following proven principles, complex member needs can be turned into intuitive digital experiences.

Here's what we've learned from our many successful PBM portal modernizations:

1. Map the User Journey

Before wireframes or technical specifications, it’s necessary to map and understand actual member, pharmacist, and employer touchpoints. This reveals friction and roadblocks that technology alone can't solve.

What We Did: Instead of jumping straight into design, our Praxent team mapped the full ecosystem. That’s where they discovered the issues driving calls, slowing prescriptions, and eroding trust.

Takeaway: Map the complete member experience before solving individual interface problems. Document where members call support, abandon tasks, and hit confusion points.

2. Remove Friction at the Point of Action

Successful modernizations remove friction exactly where members need to take action. Members should be guided through complex workflows and prior authorizations by progress updates and prompts, so there’s zero need for phone calls. Personalized cost estimates take the place of generic benefit summaries, and digital document delivery eliminates form searches.

What We Did: Our experts adapted the interface to reduce users' cognitive load by utilizing real-time prompts, visual status indicators, and mobile-optimized flows.

Takeaway: Eliminate friction at the moment of member action, not just at the point of login. The best member experiences anticipate what members need and provide it without extra steps.

3. Integrate Modern UX Without Removing Core Systems

Many PBMs assume modernization means replacing everything and requires ripping out the core systems to start over. Yet, new member portals can integrate seamlessly with existing systems and benefit configuration platforms without requiring expensive data migrations.

With the right technology partner, PBMs can gain modern member experiences faster and with less risk, launching improved member portals in months.

What We Did: Leveraging our extensive experience, the Praxent team integrated new user experience layers into the PBM’s existing claims processing and authorization systems. Their core infrastructure remained stable while the interface was modernized.

Takeaway: It’s possible to build modern experiences on proven infrastructure. New portals can be integrated with existing claims processing engines, pull real-time data from current accumulator systems, and link to working connections for pharmacy networks and provider directories.

4. Prioritize Mobile + Member Validation

Design for how members will regularly use your portal. Keep self-service top of mind as instant digital answers replace support calls. Prioritize mobile experiences that work since that’s the method most members use to access information.

What We Did: User testing happened throughout development, not just at the end. Real member feedback shaped design decisions before development costs accumulated.

Takeaway: Design for mobile-first member needs. Ensure phone-optimized workflows for real-world usage patterns.

Proven PBM Portal Expertise Makes Modernizing Seamless

Modernizing a member portal this way can be a shift for how PBMs think about digital. While the case for taking action is clear, the path forward doesn’t require boiling the ocean.

Partnering with an expert in PBM modernization like Praxent helps to make the entire process move faster without risking your everyday business operations. Praxent’s experts bring the right mix of PBM workflow knowledge, UX expertise, and engineering depth to deliver the kind of portals that work for your members, clients, and support team.

We’ve helped PBMs move from single-digit adoption rates to portals people actually use. Our understanding of pharmacy benefit management’s intricate systems means we can uncover friction, redesign claims and prior auth logic, and translate that complexity into intuitive digital experiences.

We've guided PBMs through portal redesigns that delivered real results, from higher adoption rates and lower call center volume to measurable gains in client satisfaction, because we understand both the technical requirements and the business outcomes that matter.

Approaching this process with a partner who specializes in integrating mobile-first flows and enabling real-time status updates, cost transparency, and compliance features, means you’ll gain a market-leading member portal experience without disrupting your proven infrastructure.

What's Next for PBM Leaders

The truth is, every PBM knows the pain points, and every frustrated portal interaction is a missed opportunity to build member loyalty and reduce operational costs.

The path forward requires treating user experience as competitive infrastructure, not cosmetic enhancement. Member-first portals don’t require a full system overhaul, but they do require the right expertise to connect real-time data with intuitive experiences.

The ones that enable real self-service can turn their portal from a support burden into a competitive advantage.

Ready to explore what member-first could mean for your PBM?