As a team of benefits strategists, we work hard every day to make sure we’re exceeding client expectations and providing the most innovative and value-generating plan designs and advisory services.
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Discover ApexApex is a team of professionals dedicated to helping employers create cultures of health and cost savings. As Indiana’s largest employee benefits-focused advisory firm, Apex is a “Best Place to Work” a dozen times over.
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Pharmacy Benefits Consulting Practice
Among Indiana employee benefits consultants, our team has the most experience in and deepest understanding of the pharmaceutical industry. The team includes three registered pharmacists, a health care attorney, former pharmaceutical industry executives, former PBM executives and nine Certified Pharmacy Benefits Specialists (CPBS).
We have the experience and insights to help your organization reduce pharmacy benefit costs so you can reallocate those savings to other initiatives.
What We Do
We Save You More on Your Pharmacy Benefits
Prescription drugs are one of the most complex aspects of employee benefits. In fact, we often find that many employers have never seen or effectively analyzed their pharmacy claims or pharmacy benefit management (PBM) contracts.
Some of the cost-saving services our team offers include:
- Increasing transparency and improving the terms of PBM contracts
- Analyzing Rx and drug-related medical claims (J or Q codes) on a regular basis
- Reconciling annual Rx claims to ensure your PBM is delivering on contract terms
We find savings because we know what to look for and where to look. And we know how to ensure discounts, rebates and other manufacturer-derived revenues pass through to the ultimate funders of employee health care — the employers — instead of to the PBMs’ profit margins.
The Kinetiq Health Rx Difference
No Other Indiana Broker Can Achieve the Savings or Match the Expertise of Our Health Care Team
Our team of health care industry professionals and Certified Pharmacy Benefits Specialists (CPBS) reviews pharmacy and drug-related medical claims and conducts PBM contract assessments to identify cost savings that translate into revenue for your organization.
We’ve been able to save our clients an average of 33% and up to 70% on their pharmacy benefits costs – without shifting costs to employees and with zero to little benefit plan disruption.
Pharmacy Benefit Consulting Services
Contract Health Assessments
Line by line, our team will review and evaluate your PBM contract to assess its strength and transparency and assign a score from “A” to “C.” With that score in hand, our team audits your entire pharmacy benefits program to identify cost-saving opportunities.
When we renegotiate your contract, we will include:
- Specific contract terms so you know exactly what you’re buying and at what price
- Pricing guarantee language to ensure your PBM is held accountable for providing the pricing as promised in the contract
RFP: Sourcing, Negotiating & Contracting
Our team conducts hundreds of pharmacy benefit RFPs per year to source better pricing and contract terms from a client’s current PBM and/or new PBM companies. We hold no allegiance to any one PBM and have a growing list of nearly 50 vendors with whom we work.
Through this proprietary RFP process, we ensure the finalized agreement has fair pricing terms and guarantees that benefit your bottom-line — not the PBM’s.
Rx and Medical Claims Review & Reporting
Our team has the unique clinical and actuarial ability to quickly identify at-risk plan members and predict financial risk. They do this by reviewing, analyzing and reporting on clients’ pharmacy and drug-related claims on a regular basis.
Actionable insights are provided by financial analysts and actuaries, as well as clinical analysts who have practical health care industry experience.
Our clients also benefit from ongoing plan management and monitoring services, implementation assistance, pricing audits, annual reconciliation, employee education, issue resolution and much more.
Success Stories
$8,000,000
We saved our clients more than $8,000,000 in the last year alone. The following are several case examples.
- July 19, 2022
Client Realizes Nearly $3M in Rx Savings in One Year
After reviewing the language of the pharmacy benefit management (PBM) contract that determined the terms and cost variables, savings opportunities were identified without changing any benefits to employees.
- August 10, 2022
$2.4M in Rx Cost Savings Identified for Financial Sector Client
Working closely with the insurance company’s reinsurance and pharmacy teams, the Kinetiq Health team came up with a solution to purchase the treatment directly from the manufacturer at actual cost while the hospital continued administering the dependent’s infusion therapy each …
Recent Insights
News and Education
- May 30, 2023
Wellness Wednesday: Setting Healthy Boundaries
Healthy boundaries are important but setting them can be uncomfortable. Here are some tips to take back control one boundary at a time.
- May 24, 2023
Wellness Wednesday: Tips for Mental Health Medication Adherence
Taking your medications as prescribed is an important part of your mental health treatment. Here are five tips to practice medication adherence and improve your overall well-being.
- March 1, 2023
Breaking Pharmacy Benefit News: Lilly Reduces Costs of Insulin
Lilly announced today that it is cutting insulin prices by 70 percent and capping monthly out-of-pocket costs at $35 for insulin lispro and Humalog effective immediately.
