Opening an onsite specialty pharmacy is extremely challenging — particularly given the effort required just to get access to purchase specialty meds, and then to get “In Network” with PBMs.
That said, ProxsysRx has developed a proven process for meeting those challenges.
Owning a successful specialty pharmacy starts with optimizing your 340B program
The first, and most important, step in planning a successful onsite specialty pharmacy is to ensure that the clinics writing the most specialty prescriptions in your system are eligible and registered with your 340B program.
Establishing a 340B specialty network
When you’re developing a specialty pharmacy tailored to your covered entity’s needs, consider the following:
You’ll need to make sure your specialty pharmacy product mix accommodates the therapies that your covered entity utilizes.
340B qualification rule sets
- Work with your third-party administrator (TPA) to identify your high-volume specialty prescribers.
- Extend eligible-date windows to account for longer timelines associated with prior authorizations and medical benefit eligibility checks.
- Ensure that your prescribers are adhering to your defined workflows, and meeting all charting requirements.
- Make sure your qualifications account for all delivery-channels through which prescriptions are sent to your specialty pharmacy — including fax, EMR and pharmacy hub.
Complex 340B specialty workflows
Custom rulesets bring more complex workflows, which increases the likelihood for claims to fall through the cracks. Be sure to identify those situations, and create partial matching rules — such as by therapy or prescriber — then thoroughly review them for qualification.
Current 340B replenishment-savings rates
It’s been estimated that up to 10% of all 340B specialty catalog pricing is inaccurate. Which is why it’s so important to routinely audit catalog pricing, to ensure that your pharmacy always had current 340B pricing for specialty drugs.
Launching a specialty pharmacy, overview
Seeking inclusion from all PBMs in your area.
Internal operations are only part of the formula for a specialty pharmacy’s success. We go in-network, securing cooperation and approval from all the major local insurers, for the PBMs that their patients are covered by. What’s more, we seek access from the drug manufacturers for what they’re prescribing — even the most egregiously restrictive manufacturers.
Overcoming 340B manufacturer restrictions
There is a workaround for 340B hospitals forced to select a single pharmacy for manufacturers’ 340B pricing — and it’s legal in many states. Hospitals can operate specialty pharmacies alongside their retail pharmacies. As long as the two operations are physically in their own spaces (working under separate Pharmacists-In-Charge), and there is no procedural, functional or personnel overlap between the two.
Stocking your specialty pharmacy.
Once you’ve gained access to buy specialty meds, you can expect to spend roughly $1 million for your startup inventory.
Specialty Pharmacies require the hiring of at least one Certified Specialty Pharmacist.
Once you open your specialty pharmacy, you still have to work (under real-life operating conditions) to align all of your practices, policies and procedures for accreditation.
Choose a partner who’s committed to your mission
If you choose ProxsysRx to support your health system’s mission, we only pay ourselves from the revenue and savings we generate on your behalf.
We take-on all the risk, so you’re never exposed to even the potential for loss.
To learn more, schedule a preliminary conversation today!