Keystone Cooperative

Cost-effective, sustainable pharmacy benefit programs require the right team. Benefits leaders seeking to reduce healthcare costs are more likely to succeed when their partners, third party administrators (TPA), brokers, and pharmacy benefits managers (PBM) are all committed to that same objective and work together to deliver results.

For leaders like those at Keystone Cooperative, the largest agricultural company east of the Mississippi with over 100 years in business, excellence is something they strive to bring to everything they do—including benefits. The Keystone HR team has their work cut out for them: deliver competitive benefits and an exceptional experience to a massive number of members. 

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The Challenge: Zero Visibility & Lack of Accountability

In 2024, Keystone Cooperative HR leaders, Marie Yorn and Angela Hudgins realized that their partners were failing to deliver on their objectives. “There was zero visibility,” explained Angela Hudgins, the former VP of Human Resources & CHRO at Keystone Cooperative. “Our broker didn't provide that, our TPA didn't provide that, and certainly the PBM didn't provide that—so, I wouldn't have even really known what to hold them accountable for.” 

While seeking new solutions to lower costs for the farmer-owned business, the duo became interested in SmithRx’s unique approach to cost containment. The accountability framework and projected savings proposed by SmithRx became the driving force for Keystone to work with a new TPA and broker that were willing to break away from legacy models, like that of OptumRx, their previous PBM.

Hudgins noted, “You have to have a broker and PBM that are aligned with your values and risk profile, know your company, aren’t trying to oversell but will maximize the benefits that you already have.”

Finding aligned partners was the start of their benefits transformation but ensuring the approach worked for members was the true test.

Advocating for the members of the agricultural cooperative, Yorn and Hudgins were determined to have little to no disruption during the transition phase. SmithRx ensured that any changes were resolved quickly and proactive analysis and communication allowed them to get ahead of disruption. “Anytime there's a change with our pharmacy plan or if we make a change, SmithRx is way ahead of the game on sending communications to our employees,” said Marie Yorn, Director of Total Rewards. 

“Communication and transparency – those are the biggest things. There are going to be stumbling blocks. Nobody expects perfection, but it's how we resolve those issues quickly and in the right way.” Hudgins added.

The Solution: A PBM That’s an Extension of Their Team

Transparency has enabled the benefits leaders at Keystone advance their total rewards strategy in varied ways. First, by having full visibility into their claims data, they are able to more accurately project spend. On the member experience front, on-demand access to claims allows the benefits team to identify and address member questions efficiently. Throughout their work, they are supported by experienced clinical and account and member service teams.

“We love our SmithRx account manager, he feels like an extension of our team and is always bringing new ways for both Keystone and ultimately our members to save money on their pharmacy benefits,” Yorn said.

SmithRx’s Drug Pathways Engine identifies the lowest net cost source for every claim  and the team helps move volume to those pathways so that members realize prescription savings. For example, SmithRx identifies members utilizing high cost drugs and finds clinically appropriate, low-cost generics or biosimilars. The true net cost is factored in, including rebates, assistance programs, and network discounts. Then, the optimal source is agnostically recommended, comparing big box, independent, mail, and specialty pharmacy pricing in real time. Members are engaged and supported end-to-end through changes utilizing communication channels they prefer. Throughout the process, benefit teams are kept in the loop so they’re able to support members and encourage cost saving behaviors.

In action, a Keystone member went from paying $300 per month for their child’s asthma inhaler to $0 through the SmithRx Drug Pathway Engine—and all it took was a simple outreach to the member. “That’s amazing because I know that the employee is saving that money and able to keep money in their health savings account for something else that they may need it for,” said Yorn. “The member experience has been great!”

It’s the innovative solution that gives Keystone control over their benefits and gives members confidence in their plan.

The Results: 40%+ Average PMPM Savings

Keystone Cooperative now has full visibility into their 100% pass-through rebates, Drug Pathway savings, and costs down to the claim level—and they’re seeing an average of over 40% savings per member per month (PMPM).

“When you think about the $1.8M SmithRx has saved us last year through September 2025, it all goes back to your overall healthcare spend and ultimately lowered our bottom line,” Hudgins said. “If you're thinking about switching from a traditional PBM to a modern PBM, run, don't walk! Traditional PBMs have outlived their usefulness."

Breaking away from the status quo can be daunting, but with aligned partners, the results far exceed the challenges. Schedule a time to speak with our team to see the difference a truly client-aligned PBM can make.