Client

A growing TPA in the Midwest responsible for over 15,000 covered lives

Challenge

For this TPA, rapid growth was creating complexity. After undergoing a merger, it had multiple contract options through multiple pharmacy consultants. In total, the TPA had agreements with four different pharmacy benefit managers (PBMs) to provide contracts for their clients.

The TPA wanted to review its options and ensure the contracts in place were as advantageous as possible for its clients.

Additionally, both the TPA and its clients had been experiencing service level issues from one of their PBM partners. It was time to reevaluate. TPA had a PBM contract negotiated by their incumbent pharmacy consultant. This contract did not have competitive pharmacy benefit pricing or contract terms.

Solution

With multiple pharmacy benefit consultants to choose from, the TPA wanted a unified strategy. After evaluating the capabilities of its consulting partners, it was clear that Innovative’s pharmacist-led approach, depth of expertise and history of driving results stood apart from the rest. The TPA selected Innovative as its consultant across its entire book of business.

We conducted a pharmacy benefits RFP and engaged PBMs directly to ensure the TPA was able to provide its clients with the options they were looking for. Our experts carefully examined contracts and renegotiated with the PBMs to secure improved savings for the TPA’s clients. Additionally, we provided alternatives to allow the TPA to begin to sunset the PBM partner with service issues.

TPA Saves Clients More Than $4.3M

Results

Before making Innovative its exclusive pharmacy benefit consultant, the TPA’s clients total pharmacy spend was $15,495,206. Our team identified savings of $4,398,129 — 28% of total spend.

Addressing PBM service levels helped to eliminate significant operational issues, while still offering market-leading pharmacy contracts that met member needs. With Innovative as its sole pharmacy benefits consultant, the TPA experiences less complexity, has improved its competitive position and will attract additional clients to generate long-term growth.

Printable Version

Download this case study

Download Now