Health Benefits, Pharmacy Costs, and Member Engagement: Lessons from IFEBP

Key takeaways

• Make effective benefits easier to use. More benefits mean more decisions for members and don’t guarantee better outcomes. Ensuring benefits are effective and connecting them deserves as much attention as adding them.

• Evaluate pharmacy and PBM value beyond the paid claim. Medication costs and access matters, but so does helping members address the conditions we’re using these medications for by helping them remove treatment barriers and build the daily habits that support better health. 

• Identifying health risk is a great starting point. Funds need to know whether the right members are getting the support they actually need to impact health and change plan performance. 

I left IFEBP thinking about how much responsibility union trustees and fund administrators carry. Healthcare costs are rising at an unsustainable pace, and union leaders are on the front lines of trying to manage the fallout. From skyrocketing specialty care expenses to the hidden complexities of negotiated rates and facility fees, the system is becoming harder to navigate—for both members and the funds that support them. At the same time, unions are being called to innovate, ensuring their members not only have access to the care and benefits they need and will actually use the benefits they’ve earned.

As a pharmacist and clinical leader at Navigate, I view those decisions through the lens of the person receiving care. Do they understand their diagnosis and treatment? Can they follow their treatment plan? What gets in the way after they leave an appointment or pick up a prescription?

Throughout the conference, I saw countless solutions addressing individual conditions and technologies designed to improve health and administration. What stood out to me was the opportunity to connect those investments with support for the whole person. For fund administrators, trustees, and the consultants advising them, that raises a practical question: How do we build a benefit strategy that members can & will use, connects with their medical care, and gives us a clear view of progress?

Benefits: Who helps the member connect the pieces?

Fund administrators, trustees, and business managers are responsible for benefits that meet a wide range of member needs. But as benefits & programs are added, finding and using the right support can become more complicated for members only resulting in further disengagement.

At IFEBP, I saw endless solutions aimed at individual conditions operating in silos with a strong emphasis on digital support. For fund administrators and their advisors those separate solutions leave them to figure out when to use each solution and how it fits into their overall benefits strategy. For members, those separate solutions mean another app, another website, and another login while leaving them to connect their benefits and the pieces of their care.

Consider Joe, a 42-year-old member managing type 2 diabetes. He may need help understanding his medications, changing eating habits, managing stress, and following up with his primary care provider. His benefits may cover each need through a different program or solution, leaving him to figure out how they fit together.

As a pharmacist and clinical leader, I see those needs as parts of the same care plan. Joe needs support that considers his health risks, daily challenges, and readiness to change. He may need to improve his blood sugar but feel most ready to start managing his sleep or stress. Clinical Health Coaching can meet him at that starting point while keeping his broader health needs and recommended medical follow-up in view.

His healthcare provider is an important part of that coaching ecosystem. Sharing relevant progress and concerns with the provider, reinforcing the treatment plan, and helping Joe complete recommended care connects the work between appointments with the care he receives during them. It also helps him bring questions and barriers back to the clinician responsible for his care.

Managing a chronic conditions, often alongside other health concerns, takes sustained work. Changing habits built over 42 years can be difficult, especially when someone is also navigating treatment, work, and family responsibilities. Digital tools can help, but members also need human support that helps them work through barriers, stay engaged when progress is difficult, and connect those efforts with their healthcare provider’s treatment plan. For members facing the greatest health risks, that ongoing, coordinated support is a critical part of turning access to benefits into meaningful health improvement.

At Navigate, this guides our approach to Workforce Health Activation. Connecting Culture, Care, and Clinical wellbeing means helping members find relevant support and follow through, with human guidance when they need it. The responsibility for connecting those services should not fall entirely on the member.

Funds need that coordination at the program level, too. Our Public & Labor Client Success team works with trustees, administrators, and benefits advisors on a shared roadmap that connects member needs with program priorities, member communications & outreach, and reporting. That gives the fund a practical plan for putting its benefits strategy into action and adjusting it as needs change.

For fund leaders and consultants, reporting should help answer specific questions: Are we reaching the members who need support? Are they completing recommended care? Are their health risks improving? Reviewing those measures together helps guide decisions about what to continue, change, or investigate.

Pharmacy: clinical value depends on what happens after the claim

At IFEBP, the pharmacy conversations I encountered focused heavily on AI and technology to improve claims processing and utilization reviews. Those capabilities absolutely matter. Accurate, timely decisions help members access appropriate treatment.

As a pharmacist, I also want to know what happens after that treatment is approved and dispensed.

A paid claim tells us a prescription was filled. It does not tell us whether the member understands how to take it, is experiencing side effects, or can afford to continue. It also tells us little about how treatment fits with other medications, work schedule, or daily choices. 

These are clinical concerns because they affect a person’s ability to follow treatment and benefit from it. Identifying appropriate medication is one part of care. Helping someone use it effectively and consistently requires continued support.

That is the value I see in integrating wellbeing and coaching into the pharmacy benefit. At Navigate, pharmacist-led coaching connects condition & medication education with support for nutrition, stress, and daily habits while reinforcing the member’s prescribed treatment plan. Bringing relevant concerns and progress back to the healthcare provider helps connect that support with ongoing medical care. The goal is to help members identify and understand what is getting in the way and to help them fit their care plan into everyday life. 

In the coaching results shared on stage at IFEBP, 56% of engaged Navigate high risk coaching members improved their A1c risk in 2025.

Our partnership with BeneCard PBF brings this approach into the pharmacy benefit. For funds and consultants evaluating pharmacy partners, I would ask how clinical support connects medication use, whole-person health, and medical care and how results and health improvement are measured. Those questions deserve a place alongside pricing, access, and claims performance.

Prevention: identifying risk must lead to action

A screening can identify elevated blood pressure or blood sugar. Its clinical value depends on what follows: helping the member understand the result(s), connect with appropriate care, and take steps to improve their health.

As a clinical leader, I want a clear plan for that follow-through. Members need to understand which results require attention, know what to discuss with their healthcare provider, and where they can get support between appointments. More urgent findings need a timely path to clinical evaluation.

Ongoing support should reflect both health risk and readiness to change. Someone with diabetes may need help understanding medications, improving nutrition, managing stress, and completing recommended care. They may feel most ready to addressing sleep or eating habits. That starting point can support the broader care plan while recommended medical follow-up continues.

At Navigate, a results review with a coach helps members understand their numbers, identify a manageable next step, and prepare for recommended follow-up with their healthcare provider. Coaching can also help uncover what makes that next step difficult, whether it is understanding what to do next, accessing care, or fitting it into daily life.

See how one county employer with union employees connected biometric results with pharmacist-led health coaching to save $4M in medical claims cost →

For funds, the question is whether biometric screenings lead to action. Did members receive a results review and complete recommended follow-up? Which barriers remain unresolved? Tracking those actions alongside changes in blood pressure, blood sugar, and other health risks gives trustees and their advisors a clearer basis for improving the benefits strategy.

See what this looks like in action. Explore our Health Dashboard interactive demo to see how union members can find recommended care and understand what to do next.

What I want funds to ask their partners

I came home from IFEBP thinking about the decisions fund administrators, trustees, and benefits advisors must make and the practical support they need from their partners to turn access to benefits into better member health.

At your next partner review or when you’re vetting a new solution, I would bring four questions:

• How do you help members find and use the support most relevant to their needs?

• How does your team involve members’ healthcare providers and reinforce their medical care?

• Who follows up when a member encounters a barrier or does not complete recommended care?

• What can you show us about participation & engagement, completed care actions, and changes in member health and how will those findings guide our next decisions?

These questions belong in a shared benefits roadmap, with clear responsibilities and regular review of progress. I know it does for us at Navigate…

Our Public & Labor Client Success team works with funds and benefits advisors to set program priorities, coordinate outreach, and review program results. A shared, multi-year plan should connect those activities to clear goals for member health, with reporting that helps trustees decide what to continue, change, or investigate.

As a pharmacist, I evaluate a care plan by whether it is appropriate, whether the person can follow it, and whether it is helping. I believe benefits, solutions, and partners should be held to the same standard.

You’re responsible for your fund’s benefits. Make sure they’re working for your members. Use this worksheet at your next partner review to pinpoint where members get stuck, agree on who will follow up, and decide how you’ll know if more members are getting the care they need.

Get the Employee Health Action Worksheet →

About the author

Jennifer Musick, PharmD, is Vice President of Clinical Strategy at Navigate, leading the clinical foundation for the company’s Culture, Care, and Clinical approach. She champions pharmacist-led coaching as a driver of behavior change, enabling organizations to achieve measurable health outcomes beyond typical engagement metrics.

In 2004, Jen pioneered one of the first pharmacist-led coaching models, focusing on chronic condition management, medication optimization, and sustained behavior change. This model drives Navigate’s clinical strategy by integrating personalized coaching, clinical insights, care gap closure, and digital experiences to support individuals across the health spectrum, from at-risk to complex conditions.

With over twenty years of experience, Jen is an expert in pharmacy practice, population health, and care delivery innovation. Her background spans lifestyle and chronic condition management, metabolic health, including GLP-1 integration, mental wellbeing for diverse workforces, and care navigation. She brings a clinical lens to benefit design, engagement, and ROI communication for HR leaders, brokers, and executives.

Jen believes better daily decisions lead to better outcomes. Through pharmacist-led support and informed engagement, she helps organizations close care gaps, improve medication adherence, and achieve lasting health improvements at scale.