Third Party Administrators
Since 1999, Envolve Pharmacy Solutions has partnered with Third Party Administrators (TPAs) to provide unrivaled pharmacy benefit services that reduce health plan costs, improve care outcomes and support client and member satisfaction, all of which contributes to our TPA partners’ ability to generate greater revenue.
The Envolve Pharmacy Solutions flexible operating platform allows us to operationally, clinically and financially bridge the gap between the pharmacy benefit and the medical benefit. We can fully and easily integrate into our TPA partner’s systems and transfer data seamlessly to medical vendors and healthcare providers, making your administration and claims processing tasks more efficient and accurate.
We are a new kind of PBM designed for the 21st Century because we manage costs and trend with leading-edge analytics, while also building our entire operation around the individual member. It enables us to customize solutions that fit each plan sponsors’ needs, and allows us true visibility into the clinical, operational and financial dynamics of each plan, which drives clear-headed decision-making.
Envolve Pharmacy Solutions for TPAs include the following:
- Integrated, total drug management
- Innovative clinical programs
- Secure online member portal
- Education and outreach for members/patients
- Comprehensive reporting
- State-of-the-art technology and analytics designed to improve individuals’ outcomes while reducing costs
- Customized formulary management
- Benefit design
- Claims processing
- 24/7/365 live member service staffed with licensed pharmacy technicians
- Robust Pharmacy Open Network with more than 65,000 pharmacies
- Limited and preferred pharmacy network options
- Online prior authorization process
- Integration with TPA and other vendor systems
- Home delivery services
- Specialty drug management through our sister company AcariaHealth
- Fraud, waste and abuse programs
- Online client access to reports
- Quarterly and annual plan review
- Prospective, concurrent and retrospective drug utilization review (DUR) programs
- Support for open enrollment meetings and benefit fairs
- Targeted communication, education, and outreach campaign support
- For members with complex health conditions, we offer completely integrated specialty pharmacy services through AcariaHealth.
For more information about our Solutions for TPAs, or to request a quote, please call (800) 413-7721.