Boosting Benefits:
An Advisor's Guide to Integrating
TPA and Pharmacy Solutions

Integrating Third-Party Administrators (TPAs) with pharmacy benefits can significantly enhance the experience for small to mid-sized employers. This integration can save money, simplify processes and even lead to healthier employees. Here are a few key reasons to consider this approach:

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1. Lower Costs: Blending pharmacy and medical benefits can help reduce overall healthcare expenses. Real-time data sharing drives smarter medication management and highlights high-cost areas like injectable drugs (J-codes), enabling better oversight and potential savings.
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2. Better Care Coordination: Effective collaboration between TPAs and Pharmacy Benefit Managers (PBMs) ensures employees receive the right medications on time. Integrated insights—including those tied to J-coded therapies—help streamline approvals and reduce delays.
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3. Improved Employee Experience: Employees appreciate a streamlined experience, including the use of a single ID card, easy access to customer service, and hassle-free Rx management.
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4. Enhanced Data Insights: Employers gain access to comprehensive health analytics, enabling them to make informed decisions regarding benefits, plan designs and potential savings.
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5. Engaged Members, Empowered Outcomes: Proactive outreach and support, combined with innovative programs, lead to higher satisfaction, better adherence, and improved health outcomes.

For growing businesses, this integration isn’t just a strategic transformation. Reducing administrative tasks alleviates some of the burdens on your team, minimizes friction, strengthens outcomes, and leads to happier employees, fostering a more positive work environment. Ultimately, this approach not only supports your staff but also contributes to long-term savings for your business.

When searching for an integrated TPA and pharmacy solution, keep these points in mind:

  • Look for clear pricing with no hidden fees.
  • Ensure real-time data integration between medical and pharmacy claims.
  • Check for customizable plan designs that meet your specific needs.
  • Understand that a dedicated support team can significantly ease the onboarding process and ongoing service.
  • Seek clinical oversight and reporting to help manage chronic conditions and improve health outcomes
  • Prioritize member engagement, as members should not be an afterthought.

Selecting proven integration partners like ABA—with deep PBM expertise and extensive industry connections—ensures you have a dedicated ally committed to your success and a trusted expert guiding you through this complex space.