Introduction.

At Hall Benefits Law (HBL), we leverage our extensive legal experience to provide unparalleled value to our clients through strategic Third Party Administrator (TPA) and Pharmacy Benefit Manager (PBM) negotiations. With deep ERISA expertise and a proactive approach to issue spotting, we consistently secure financial benefits and compliance improvements for plan sponsors.

This case study explores how HBL’s unique methods have created over $50 million in value for clients engaged in TPA and PBM negotiations, positioning them for long-term cost savings, risk mitigation, and financial transparency.

A Legacy of Excellence in ERISA and Negotiations.

Since its founding in 2013 by Managing Partner Anne Tyler Hall, HBL has established itself as a leading ERISA boutique law firm in the United States. With a background in tax law from Georgetown University and experience at premier firms such as Alston & Bird and King & Spalding, Anne Tyler Hall has built a team that now boasts 150 years of collective ERISA experience.

This depth of knowledge enables HBL to navigate the complexities of both TPA and PBM agreements with unmatched proficiency, ensuring plan sponsors receive maximum financial value, transparency, and compliance assurance.

The Core of Our Strategy: Proactive, Tailored Negotiations

At HBL, we approach TPA and PBM negotiations with a client-focused strategy designed to optimize cost structures, enhance transparency, and ensure compliance.

Our process begins with a detailed contract review, identifying terms that can be renegotiated for financial savings and compliance improvements. We leverage key provisions from the Consolidated Appropriations Act (CAA), No Surprises Act (NSA), and emerging state PBM regulations to:

• Reduce excessive fees in TPA administrative costs and PBM pricing models
• Ensure transparent rebate pass-throughs in PBM contracts
• Strengthen performance guarantees and service obligations

Our review process frequently uncovers contractual inefficiencies that, when renegotiated, yield substantial financial credits, rebates, and direct cost savings. For example, we have successfully renegotiated both TPA and PBM contracts to:

• Improve rebate structures in PBM agreements
• Modify cost-sharing arrangements in TPA contracts
• Strengthen performance guarantees across both agreements

These strategic revisions are not just about compliance—they translate directly into financial wins for our clients.

Real-World Impact: Creating Value for Clients

Our work has led to significant, measurable financial outcomes. HBL has accumulated over $80 million in penalty avoidance and abatements for our clients since 2018. A substantial portion of this success stems from our expertise in health and welfare benefits, ensuring that both TPAs and PBMs adhere to their contractual and regulatory obligations.

Examples of Our Success:

• Negotiating Credits and Rebates: HBL has secured multimillion-dollar financial credits through strategic negotiations with TPAs and PBMs, leveraging legislative clauses to argue for more favorable financial terms.
• Reducing Cost-Containment Program Fees: We have successfully eliminated unnecessary TPA fees related to cost-containment programs and restructured PBM agreements to eliminate spread pricing and enforce 100% rebate pass-throughs. These adjustments have resulted in millions of dollars in annual savings for plan sponsors.
• Enhanced Compliance Measures: Our firm has helped plan sponsors implement compliance safeguards that align with CAA, NSA, and PBM-specific regulations, thereby mitigating fiduciary risk and avoiding costly penalties.

Holistic, Partner-Driven Collaboration

At HBL, we differentiate ourselves through a client-first, partner-driven model that ensures high-touch, strategic engagement throughout the TPA and PBM negotiation process.

Unlike traditional big law firms, where junior associates often handle key contract negotiations, HBL provides comprehensive, senior-level oversight that maximizes value while reducing legal costs.

We are committed to partner-level engagement, ensuring that clients receive strategic insights from seasoned ERISA attorneys at every step of the process.

Our strategic focus extends beyond immediate financial gains—we invest in long-term value creation, establishing strong TPA and PBM agreements that:

• Ensure continuous cost savings
• Improve financial transparency
• Reduce compliance risks

The HBL Difference: Why Clients Choose Us

HBL stands out as a nimble, proactive law firm that delivers big-firm results with a personalized approach. Our consistent recognition as the fastest-growing ERISA boutique law firm (2018-2024) and inclusion in the Inc. 5000 list reflects the trust and confidence our clients place in our services.

What sets us apart?

• Expertise Across All States: We serve clients in 40 states, combining local regulatory knowledge with national expertise.
• Proactive Issue Spotting: Our preventive approach ensures clients can address risks before they become costly liabilities.
• Long-Term Savings and Peace of Mind: Our contract negotiation strategies protect plan sponsors from hidden fees and legal exposure, ensuring sustainable financial benefits.

Conclusion

At Hall Benefits Law, creating value through TPA and PBM negotiations is more than a mission—it is our proven track record. Through strategic contract negotiations, proactive legal guidance, and a commitment to fiduciary protection, we help plan sponsors save millions, maintain compliance, and optimize their benefits programs. Our deep ERISA expertise, collaborative culture, and client-centric approach ensure that every TPA and PBM negotiation is managed with precision, strategy, and long-term value creation.

If your organization seeks to optimize its TPA and PBM agreements to secure significant cost savings and enhanced compliance, HBL is ready to be your trusted negotiation partner. Contact us today to learn how our expertise can make a measurable difference for your organization.