Mercer reported that 61% of employers with 500 or more employees were actively evaluating new approaches to offering or managing pharmacy benefits.¹
For TPAs, that creates opportunity. It also raises the stakes.
When a TPA brings a PBM into an employer or consultant conversation, it is putting more than the PBM’s name in front of the client. It is putting part of its own reputation behind the recommendation.
So what makes a pharmacy benefit solution easier to stand behind?
The economics can be explained without a translation guide
Price matters.
But a TPA also has to answer the next question:
Why does this model cost what it costs?
That may mean explaining fees, rebates, formulary strategy, guarantees or how a proposed change could affect net prescription drug cost.
It may also mean explaining what the PBM can do about specialty drugs, GLP-1s, biosimilars, and other cost drivers.
The TPA does not need every technical detail memorized. It does need a clear story it can explain and defend.
The choices are usable
Different employers may want different pharmacy benefit strategies.
That is valuable only if the TPA can offer those choices without building a different pharmacy benefit operation around every client.
A stronger model lets the TPA explain:
Here are the choices. Here is what changes. Here is what stays consistent underneath.
That is more useful than simply calling a PBM flexible.
It gives the employer a decision it can understand and gives the TPA confidence that the choice will still work after the sale.
The proof looks like the buyer’s real world
A large employer success story can be useful.
But a TPA has another question:
Can this PBM support different employer groups at the same time, with different needs, rules and strategies?
The challenge is not only scale.
It is variation at scale.
Implementation, claims, service, reporting and pharmacy benefit strategy all have to keep working as the book changes.
That means proof should look like the clients the TPA actually serves. Similar size matters. So do benefit complexity, implementation needs, specialty exposure and service expectations.
The PBM knows how to sell beside the TPA
Sometimes the TPA should lead the conversation.
Sometimes the employer or consultant wants deeper pharmacy benefit expertise.
A good PBM partner should know when to step in without taking over.
That can mean helping with opportunity analysis, RFPs, pricing, employer meetings or finalist presentations.
When the TPA owns the client relationship, the PBM should strengthen that relationship by bringing the pharmacy benefit expertise needed to move the conversation forward.
Member problems do not become TPA problems by default
A pharmacy benefit can look strong in a proposal and become much harder to stand behind if prescription issues repeatedly come back to the TPA.
Member support matters commercially too.
When a prescription need becomes complicated, the PBM should own the next step on the pharmacy benefit issue and stay accountable through resolution rather than turning the TPA team into the pharmacy benefit help desk.
Clear ownership matters to the member. It also matters to the TPA trying to maintain a strong client relationship.
The service story still works after the sale
A solution can be easy to sell and difficult to live with.
If implementation creates avoidable disruption, member issues repeatedly come back to the TPA or nobody can explain performance at renewal, the original sales promise starts to lose value.
The stronger pharmacy benefit story carries through from proposal to implementation, ongoing support, plan review and renewal.
That matters for retention. It can also make the next opportunity easier.
The TPA has to be able to stand behind the recommendation
Before putting a PBM in front of an employer, a TPA should be able to answer four questions:
Can I explain it?
Can I show why it fits this client?
Can I trust the organization to execute?
Will I have something useful to show the client after the sale?
Those are not just sales questions. They are a good test of whether the partnership will work.
Your next employer opportunity or renewal is a good place to put those questions into practice.
LucyRx’s TPA Growth Opportunity Review is a working conversation about how your pharmacy benefit strategy can help you win new employer business, strengthen client relationships and deliver after the sale. Bring a specific opportunity or your broader growth priorities, and let’s explore where we can help.
https://lucyrx.com/wp-content/uploads/2026/10/featured-image-2.png
536
800
Lisa Hazen
/wp-content/uploads/2025/03/LucyRx-Logo-Primary.svg
Lisa Hazen2026-10-22 14:20:522026-10-22 14:20:52When Women’s Health Reaches the Prescription, the Pharmacy Benefit Still Has Work to Do
Share