July 25, 2024
Third Party Administrators (TPAs) have a unique relationship with Pharmacy Benefit Managers (PBMs). Understanding and managing this dynamic is essential for delivering efficient and effective services to clients. As a pharmacy benefits consultant, Innovative Rx Strategies helps to bridge the gap between TPAs and PBMs, ensuring that TPAs can provide the best possible service to their clients. TPAs face a variety of challenges in their interactions with PBMs. Let’s examine them, and how Innovative Rx Strategies’ services support and enhance TPA pharmacy benefits offerings.
The Dynamic Between TPAs and PBMs
For TPAs holding the Master Service Agreement (MSA), they are the primary point of contact for their downstream groups, providing pharmacy discounts, rebates and plan designs. Therefore, when issues arise, it is the TPA that faces the brunt of the blame, this makes it crucial for PBMs to understand their role in supporting TPA.
TPAs are not payors; they are facilitators. Effective management of this segment requires a dedicated team that understands the TPA’s operational framework.
It is also vital that TPA have support from PBMs for quick implementation and plan changes as onboarding of clients happens quickly and often. Delays in implementation can hinder TPA’s ability to perform efficiently.
Master Contracts: A Game-Changer for TPAs
Master Contracts are central to a TPA’s ability to offer pharmacy benefits to their downstream groups. Historically, full-service TPAs did not focus heavily on pharmacy benefits, but this has changed over the past 5-7 years. A Master Contract allows TPAs to manage their operations more effectively.
Our approach to Master Contracts helps TPAs streamline their services and offer consistent, competitive pricing to their clients. Coupling aggressive negotiations of discounts and rebates with proprietary contract terms and conditions leads to best in market opportunities which TPAs can offer to their downstream clients. This in turn helps the TPA’s clients maximize their savings on pharmacy benefits. Master contract templates not only save time and resources but also enhance the TPA’s marketability and ability to attract new business.
White-Glove Service: Elevating TPA Support
Our white-glove service is designed to provide comprehensive support to TPAs, encompassing several key components:
Strategic Plan Design Development
We work closely with TPAs to develop strategic plan designs. Our unique expertise in the TPA market allows us to create innovative strategies that go beyond traditional ideas of plan design, addressing specific needs and gaps in the market.
Implementation Support
For growing TPAs, onboarding and implementing new clients is a constant and critical process. Ineffective or inefficient implementation can be a major barrier to long-term success. We have developed streamlined implementation processes. These include forms, template plan designs and support structures that facilitate rapid onboarding of new clients, often within a week. This quick turnaround helps TPAs maintain competitiveness and improve client satisfaction.
Day-to-Day Member Issue Resolution
We pride ourselves on relieving TPAs of the heavy lifting associated with day-to-day member issues. Our team is always ready to field questions, coordinate with PBMs and resolve any operational challenges that arise. This proactive approach ensures that minor issues do not escalate into major problems, maintaining smooth operations for the TPA.
Strategic Trend Reporting & Pharmacist Support
TPAs need detailed, actionable data to support their clients and brokers. Innovative provides strategic trend reporting at the client level, enabling TPAs to present comprehensive analyses. Our behind-the-scenes support ensures that TPAs can confidently showcase their expertise and value to clients and prospects. When requested, we also support TPAs by sending one of our experts to assist with trend presentations.
For full-service TPAs, offering a holistic product that includes clinical pharmacist oversight is a significant value-add. Innovative has multiple pharmacists on staff ensuring meticulous attention to the clinical aspects of pharmacy benefits while minimizing member noise and enhancing client satisfaction.
Marketability Enhancement
Our approach to pharmacy benefits consulting also helps TPAs stand out to prospective clients. We provide customized analysis for prospective group repricing requests, equipping TPAs with detailed comparisons of PBM offerings and insights. This empowers TPAs to present compelling, well-informed proposals that demonstrate their capability and expertise. Many of our TPA clients have seen exponential growth in their client base after partnering with us.
Our TPA Pharmacy Benefits Philosophy: Reduce Heavy Lifting, Improve Contracts
The relationship between TPAs and PBMs is complex and often full of challenges. However, with the right support and strategic partnerships, TPAs can navigate these difficulties effectively and set themselves apart from the competition. Innovative provides the expertise, resources and dedicated support that TPAs need to thrive in this competitive landscape. By bridging the gap between TPAs and PBMs, we help TPAs enhance their services and attract new business.
The first component of this approach is reducing the administrative burden on TPAs. By handling the intricate details of pharmacy benefit management, we enable TPAs to focus on their core operations. We help negotiate contracts, resolve member issues and provide strategic support.
The second component of our approach to TPAs is delivering aggressive contracts that provide best-in-class value and savings opportunities to downstream clients. This allows TPAs to continue to improve their competitive position and attract new clientele. The results speak for themselves. Learn more about our latest TPA case study by clicking the link below.