Pharmacy Benefits Services & TPA Solutions

Pharmacy benefits administration and management services for self-funded employers and third-party administrators that want to optimize their member experience while improving financial outcomes.

Improve Quality of Member Services and Contain Benefit Program Costs

Enable better patient care through pharmacy   

Pharmaceutical spending by commercial plans, government-sponsored programs, third-party administrators, and individual consumers continues to rise.

Prices for all drugs — including branded, generic, and specialty medications — are increasing rapidly, and patients are often challenged by the complexity of drug regimens. Many patients never begin prescribed therapies or fail to adhere to them correctly, which can lead to negative long-term health outcomes.  

Our Pharmacy Benefits Services division helps our customers understand the ramifications of prescription drug non-adherence. We provide members with options that help them effectively manage their costs as they pursue treatments that impact their overall health. 

Impact clinical and financial outcomes 

We collaborate with you to develop effective strategies, solutions, and technology infrastructure to support better outcomes for your specific pharmacy programs and patient populations.

We help employers, Medicaid plans, and third-party administrators control costs and support appropriate pharmaceutical use through a variety of programs. We strive to establish customized programs that support your particular membership.

We will never lose sight of cost containment and patient well-being. We understand that each of your members faces unique challenges, and we work hard to deliver a personalized message to address every individual’s needs.

Adapt to Changing Member Needs

Tailored Pharmacy Solutions

Customized support to control costs

We understand the specific pharmacy needs – and the respective challenges – of our customers in the employer, third-party administrator (TPA), and Medicaid segments. For each segment, we offer clinically-driven, evidence-based solutions to help you control costs and ensure proper utilization.

Our proprietary claims adjudication platform works seamlessly with a variety of tools designed to help you manage patient cases, support proper utilization, and increase cost efficiencies.

Employer and TPA Plan Solutions

Flexibility to support better outcomes

Change Healthcare’s Smart Commercial Pharmacy Services offer employers and third-party administrators an adaptable, flexible platform to keep up with changing consumer demands.

Services include pharmacy claims adjudication via our proprietary claims processing system, distribution channel management (retail, mail and specialty), and other business and clinical programs designed to improve member health while controlling prescription drug costs.

Medicaid Solutions

Patient-centered programs

State Medicaid plans and their members face a unique set of challenges to achieving success in their pharmaceutical programs.

Change Healthcare takes a patient-centered, clinically driven approach to its Medicaid Pharmacy programs, offering solutions for claims adjudication, rebate management, prescriber correspondence, patient case management, and other programs. 

Explore Our Pharmacy Benefits Services & TPA Solutions