Five Pharmacy Benefit Questions Every TPA Should Be Ready to Answer in 2027

Employers are asking harder questions about the pharmacy benefit.

And they should be. Pharmacy now represents 25% of employer healthcare spending, and Business Group on Health estimates employer drug costs will rise 12% in 2026. Employers are also taking more active approaches to GLP-1s, specialty drugs, biosimilars and PBM strategy.¹

For a TPA, being ready does not mean having one standard answer for every employer.

It means understanding the options, knowing what can and cannot change, and being clear about who owns what when a decision has to be put into practice.

Here are five questions I would expect to hear more often in 2027.

1. What are we actually paying, and what can we verify?

A low administrative fee does not tell the whole economic story.

Employers may want to understand rebates, fees, guarantees, exclusions, formulary decisions and what those pieces mean for the net cost of the medications their plan is paying for.

The better question is not simply, “What is the discount?”

It is:

What will change the plan’s actual cost, and what information will we have to verify it?

A TPA should know where the numbers come from, which assumptions matter and how performance will be explained after the contract is signed.

2. What is our strategy for GLP-1s, specialty drugs and other high-cost therapies?

There is rarely one right answer across a TPA’s entire book of business.

One employer may want different coverage criteria for GLP-1s. Another may be evaluating a different access model. A third may have a significant biosimilar opportunity.

The TPA does not need to make the clinical decision.

But it should be able to explain the available choices, what each choice changes and how the PBM will manage the clinical, financial and member implications.

Flexibility only matters if the PBM can make those choices work in practice.

3. What can this client actually control, and what will we be able to see?

This question goes beyond plan design.

Can the employer choose among formulary approaches, pharmacy networks, specialty strategies or clinical programs?

What does the contract allow if the client wants to use another partner?

What claims and reporting data will be available?

Who can make a change, and what has to happen to put that decision into practice?

Meaningful control is not simply a long menu of options. The employer and TPA need to understand what can change, what information they will receive and what happens operationally when a different choice is made.

4. What will happen during implementation?

This is where what was promised before the sale has to work in practice.

Eligibility has to be correct. Accumulator balances, which track member deductible and out-of-pocket amounts, have to transition and reconcile correctly. Claims and reporting connections have to work. Members may need help with formulary changes, prior authorizations or pharmacy access.

A TPA should know:

Who owns each piece, what gets tested before launch and what happens when something does not work as planned?

A strong go-live is not separate from the client relationship. It becomes part of it.

5. Can this PBM support the differences across our book without creating more work for our team?

This may be the most TPA-specific question of all.

Different employer clients may choose different formularies, networks, clinical programs or cost-management strategies.

The test is not whether the PBM can configure one employer.

It is whether the PBM can support those differences across the TPA’s book while maintaining reliable claims, service, reporting and issue ownership underneath them.

The relationship may also need to extend beyond administration. TPAs may need pharmacy benefit expertise during opportunity analysis, RFP responses, finalist meetings, implementation, plan reviews and renewal.

The real test is whether the PBM helps the TPA support different employer needs without handing the complexity back to its team.

Readiness is not having one answer

Different employers will make different choices.

A TPA does not need one pharmacy benefit strategy for every employer in its book. It needs to understand the choices, know who owns what and have a PBM partner that can make those choices work without handing the complexity back to the TPA.