Formulary Change Alert

When a plan moves a drug to a different tier, the member usually finds out at the pharmacy counter, when the price comes out different than last time. That's the moment people start blaming the plan and shopping around. This campaign gets to them first. The AI lets them know their plan changed its drug list, finds out which medications they're on, and gets them to their agent to sort out what it means.

The tone is calm and practical. It's a heads-up, not an emergency. The AI never quotes a price and never suggests a different medication. That's between the member, their doctor, and their agent.

In the messages below, anything in brackets fills in for each member: [First name], [AI name] (whatever you've named your AI employee), [Agency], [Agent name] (their assigned agent), [Agency phone], and [Carrier].

At a glance

How people get in

There's no automation on this one. You add people yourself. See Add Customers to a Campaign.

Who to add: members on a plan whose formulary just changed, who take one of the drugs that moved. The AI doesn't get the drug name from careCycle (it asks the member which ones they take), but it does tell them "it looks like it affects one of your medications." So only add people where that's actually true, not everyone on the plan.

What the AI says

The campaign comes with three AI employees: one for daytime calls, one for after hours, and one for appointment callbacks.

Daytime calls (the main one)

The call opens with:

Hi [First name], it's [AI name] calling from [Agency], did I catch you at an okay time?

Once they confirm, the AI gives the reason:

Oh hey [First name], so uh [Agent name] wanted me to give you a heads up, your plan made a change to its drug list and it looks like it affects one of your medications.

Then it lets them react and asks:

Do you know which ones you're on right now? I just wanna make sure [Agent name] is looking at the right thing.

It writes down the medication names they give (and never guesses at a name it didn't hear clearly). Then it's honest about what it knows: the plan changed how it covers that drug, it doesn't have the new cost, and their agent can pull up exactly what it'll be and what their options are. It offers to book a time with their agent, or transfer them now if they'd rather deal with it while they're on the phone. If they want neither, it logs the medications for your team and lets them know they can call or text this number.

Before it wraps up, it says one practical thing, once: if they refill before talking to their agent, the price might come out different than usual.

It's also ready for the stuff people say on these calls:

• "How much is it going to cost now?" It's honest that it doesn't have that number and never estimates one. It gets them to someone who can look it up.
• "Should I stop taking it?" This is the one place it's firm: don't change anything on your own, talk to your doctor and your agent.
• "Can I switch plans?" It doesn't explain enrollment rules or suggest switching. It notes that they asked and routes it to their agent.
• "Why did they do this?" It doesn't make up a reason or knock the carrier.
• They're scared about affording it. It takes it seriously, doesn't make promises about savings programs, logs it as urgent, and gets them to a person.
• "I'm not on that anymore." It notes it so your records get corrected and keeps the call short.
• "Are you a robot?" "I'm a virtual assistant, I help [Agent name] with client calls."
• "Take me off your list." It confirms they'll be removed and lets them go.

After hours

Same conversation, but nobody's around to take the call live. So instead of a transfer or booking, it lets them know nobody's at their desk right now and makes sure their agent follows up to walk through everything. If someone calls in after hours, it greets them, lets them know the team isn't available, and takes down their details and reason for calling.

Appointment callbacks

When an appointment comes up, this employee makes the callback. It mentions the recorded line, says it's calling on behalf of their agent about their scheduled appointment on their [Carrier] plan, checks that now still works, and transfers them to the team. If now's bad, it finds a new time on your calendar and books it. It doesn't answer medication or cost questions on this call, it just gets them to the person who can.

The cadence

Day 1: Call

Text, a few minutes before the call:

Hey [First name], it's [Agency]. There's been an update to your [Carrier] drug list, so we're giving you a ring in a minute to see if it touches anything you take. Quick one.

Voicemail if they don't pick up:

Hi [First name], it's [AI name] with [Agency]. Your [Carrier] drug list was updated, and we're checking in with folks to see whether anything on it touches their prescriptions. There's nothing you need to do today. Give us a call back at [Agency phone] whenever it's convenient and we'll go through it with you.

Day 1: Text (if we didn't reach them)

Missed you just now. It's only about the update to your [Carrier] drug list, nothing you have to do today. We'll try you again, or catch us at [Agency phone].

Day 2: Call

Text, a few minutes before the call:

[First name], trying you again here in a couple minutes about the update to your [Carrier] drug list. Nothing's wrong, we just like to go over these with you.

Voicemail if they don't pick up: the same one as Day 1.

Day 2: Text (if we didn't reach them)

Looks like we keep missing each other, no worries at all. Anytime you want to go over the update to your [Carrier] drug list, call us at [Agency phone] and we'll take care of it.

After that, the journey ends.

How each call works

• If they get transferred, book an appointment, or the AI logs an inquiry, they're done. The journey ends right there. Booking an appointment ends all of that member's active campaigns.
• If they talk to the AI, they're done too, whether the call wraps up normally, they're confused about their policy, or they ask to cancel.
• If we can't reach them (no answer, voicemail, "call me later" without booking, or the call drops right away), they get the follow-up text and move to the next call.
• If it's a bad number, or they ask not to be called, they're stopped right away.

Calls and texts only go out during your business hours and between 8 AM and 9 PM in the member's time zone.

Before you turn it on

• Set up your escalations in Employees > Escalations. Point Transfer Call at a transfer destination and Book Appointment at an appointment configuration. The campaign can't be activated until both point somewhere. Inquiries go to your Inbox and the Inquiries page automatically, and that's where the medication names show up.
• Check your member data. The AI needs each member's first name, last name, carrier, and assigned agent, plus your agency name. People missing any of these get skipped, and so does anyone without a phone number or a time zone or state.
• Check your caller ID. Out of the box, this campaign calls from your agency's main number (the one your Receptionist answers), so make sure you have one. You can see this on the Phone Numbers tab: Use organization main number for outbound calls is switched on. Want it to call from its own number instead? Switch that off and add a number there (you can only change it while the campaign isn't active). See Managing Your Phone Numbers.
• Get SMS registration done so the texts can go out. See SMS and RCS Registration.
• Test it. See Test Your Campaign.
• Click Activate on the Overview tab, then add your members.

Changing any of this

• What the AI says on calls: the Employees tab. See Edit Your AI with Employees.
• Texts, voicemails, and timing: the Pulse tab. Click any call or text step to edit it. See Pulse.
• Who gets in: you add people yourself. If you'd rather have them come in automatically, set it up on the Automations tab. See Automations Explained.