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.
- What We Do
- Who We Are
Who We Are
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.
- Our Insights
Our Insights
Access InsightsOur team of subject matter experts is dedicated to disrupting the health benefits industry and providing thought leadership, public policy advocacy and benefits education.
- Contact Us
Toggle Navigation
Toggle Navigation
Toggle Navigation
Toggle SearchWho We Are
Pharmacy Benefits Consulting Practice
Among Indiana employee benefits consultants, our Kinetiq Health Pharmacy Benefits Consulting Team has the most experience in and deepest understanding of the pharmaceutical industry. The team includes three registered pharmacists, a health care attorney, a former pharmaceutical industry executive, 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 CPBS 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 Kinetiq Health Pharmacy Benefit Consulting 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 the Kinetiq Health Rx team as well as Kinetiq Health’s financial analysts, actuaries and other 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
Apex’s Kinetiq Health Pharmacy Benefits Consulting team saved our clients more than $8,000,000 in the last year alone. The following are several case examples.
- 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 …
- September 20, 2022
Large School System Builds $14.3M Reserve in Five Years
Prior to Apex becoming the strategic advisor, this client also had a near-site clinic available to all members on the medical plan. After a thorough review of clinic data, our team found that the cost per visit exceeded $225 due …
- November 1, 2021
Apex Rx Expertise Helps Client Cut Spend By More Than a Third
The savings found were substantial for the client. After discounts, rebates and fees the annual identified pharmacy savings were $110,156 for the client. Apex also discovered additional savings through clinical and specialty drugs of another $100,581. Those combined savings cut …
Recent Insights
News and Education from the Kinetiq Health Team
- August 30, 2022
Wellness Wednesday | Don’t Ignore These Warning Signs of Diabetes
Millions of people in the United States have diabetes and don’t even know it. Signs and symptoms of diabetes aren’t always obvious and sometimes go unnoticed for several years before someone receives an official diagnosis. Understanding symptoms and catching them …
- August 23, 2022
Wellness Wednesday | 7 Tips for Reviewing Medications With Your Health Care Provider
Whether you purchase your medications at the same pharmacy or multiple locations, it is important that you always have on hand one document listing everything you’re taking and that you regularly update this list with your most current medications and …
- March 23, 2022
Stop Loss and Medical Plan, Rx Savings Result in Richer Benefits
MSD of Wayne Township was dedicated to employee health and wellness prior to engaging with Apex Benefits and its Kinetiq Health team in late 2019. While mostly satisfied with their wellness program, the school system was looking for opportunities to …
Pharmacy Team
-
Read BioMegan Dorrell, PharmD, BCACP
-
Read BioJoni Fallowfield, CPBS
-
Read BioTaylor Fisher, CPBS
-
Read BioMark Goodpaster, CPBS
-
Read BioJim Harenberg, CPBS
-
Read BioStan Jackson, CPBS
-
Read BioScott Long, CPBS, CHVP, CSFS
-
Read BioAndy May, CPBS
-
Read BioSarah Michaels, RN, CPBS
-
Read BioToni Stinson, CPBS