Enhancing Patient Care and System Revenue: A Win-Win Proposition

ADDITIONAL BENEFITS

Improving medication adherence among 340B patients

Medication non-adherence is the number one cause of unnecessary patient readmissions. Onsite specialty pharmacies can play a pivotal role in improving medication adherence among the patients at greatest risk of burdening hospitals with costly, unnecessary, compliance-related readmissions.

Overcoming 340B ESP and drug manufacturer restrictions

There is a workaround, in many states, for 340B hospitals forced to select a single pharmacy for manufacturers’ 340B pricing. Hospitals can operate specialty pharmacies alongside their retail pharmacies — as long as the two operations are physically in their own spaces, and there is no procedural, functional or personnel overlap between the two.

Facilitating clinical research and innovation

Onsite specialty pharmacies can serve as valuable resources for 340B hospitals that conduct clinical research. With access to a wide range of specialty drugs and patient populations, these pharmacies can participate in drug trials.

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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:

• 340B THERAPIES
• 340B QUALIFICATION RULE SETS
• COMPLEX 340B SPECIALTY WORKFLOWS
• CURRENT 340B REPLENISHMENT-SAVINGS RATES

Launching a specialty pharmacy: An overview of our process

• SEEKING INCLUSION FROM ALL PBMS IN YOUR AREA
• OVERCOMING 340B MANUFACTURER RESTRICTIONS
• STOCKING, STAFFING, OPERATIONS

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Since 2019, ProxsysRx has generated more than $500 million in 340B savings and revenue for the health systems we serve. We work with hospitals to unlock pharmacy’s potential throughout the continuum of care.

We optimize revenues from their 340B programs and their retail pharmacies, then implement strategies for funding onsite specialty pharmacies from those savings and revenues. The ultimate goal is for hospitals to pay nothing out of pocket to build their own specialty pharmacies.

ProxsysRx’s process for funding 340B specialty pharmacies: An overview

Use savings from your 340B program.

Set-aside some of the retail-prescription revenue from your most profitable 340B drugs (IE: “soft specialty” prescriptions like Humira) to help fund your upfront costs. That way, you can build-out your specialty pharmacy capabilities over time, without committing a large capital expenditure from your budget.

Use your hospital’s retail pharmacy revenue.

A well-managed retail pharmacy can, and should, generate significant revenue and profits for your health system. ProxsysRx owns or manages outpatient pharmacies in hospitals nationwide, and — on average — those pharmacies generate $750 to $1000 in net profit per bed, per month. Which means, for instance, that a 200-bed hospital can expect to generate $150,000 to $200,000 in monthly net profit from its onsite retail pharmacy.

Implement an effective Readmission Reduction program.

Up to 70% of all preventable readmissions are due to patient prescription non-compliance. ProxsysRx launched its first readmission reduction program in 2023. After 15 months, readmissions among patients with three or more prior admissions had dropped 77% — while readmissions among patients with Uncontrolled A1C dropped 93% — resulting in an estimated savings of $1.25 million for the health system.

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Below are highly-condensed excerpts from an in-depth roundtable discussion of specialty pharmacy best practices. To watch videos of that discussion, organized by topic, Click Here. You can also find a curated transcript of the discussion here.

NURTURE STRONG PHARMACIST / PROVIDER RELATIONSHIPS

It’s critical that you hire specialty pharmacists capable of building healthy working relationships with your clinic teams.

CREATE AN EQUALLY-STRONG RETAIL / SPECIALTY PHARMACY RELATIONSHIP

Both pharmacy teams should know what the other is doing, as far as providing for those patients — even to the point of combining prescriptions in single shipments.

REACH-OUT TO MANUFACTURERS FOR PARTNERSHIP OPPORTUNITIES

Bringing a drug to market requires a lot of research, and many manufacturers want active patients on their research medication.

IDENTIFY PRESCRIPTIONS YOU CAN FILL BEFORE ACCREDITATION

While accreditation can take 6 months to a year, you can actually start filling some 340B prescriptions on Day One.

IMPLEMENT SHIPPING & PACKAGING PROTOCOLS

Most, if not all, of the medications specialty pharmacies dispense are delivered to a patient’s door. Which is why they have to implement appropriate shipping and packaging protocols.

INTEGRATE THE PHARMACY’S TECH WITH THE HEALTH SYSTEM’S

You’ll need a technology platform, like ProxsysRx’s, that can pull all the data — and create the necessary outlooks and outputs.

INTEGRATE SPECIALTY PHARMACY WITH 340B

Your 340B and specialty teams both need to understand the best practices for working within your hospital’s 340B program.

AVOID NEGATIVE REIMBURSEMENTS

One of the easiest ways to cause negative reimbursement is not paying attention to the 340B status of a particular dispense.

UNDERSTAND THE PRIOR-AUTHORIZATION PROCESS

Many PBMs will not pay for prescriptions right out of the gate, so there are a lot of payor hurdles you have to jump, in order to get drugs covered.

KNOW YOUR COPAY ASSISTANCE OPTIONS

Most patients can't afford high copays, so you need to know all the available options for copay assistance.

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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!