Topic #2: Ensuring Favorable Contracting
In this five-part blog series, we explore the top challenges that community health centers face when running profitable, efficient, and impactful in-house pharmacies. In Blog #2, we cover the topic of negotiating favorable contracting with a wide array of health plans.
For every community health center (CHC), serving the broadest population of patients is essential. In order to ensure you remain in-network with as many plans as possible, health center pharmacies must be able to negotiate favorable terms. As insurance premiums rise along with the cost of coverage, many pharmacies are finding it more and more challenging to reach ideal terms.
Naturally, there are many factors to consider when beginning negotiations. Not only do you have to consider financial guarantees for discounts off average wholesale price (AWP), dispensing fees, administrative fees, and rebates, but it’s important to consider how these individual pricing components across payer organizations will impact your overall costs and revenue forecasts.
Here are three essential questions every CHC should ask:
- Are your payer and vendor agreements competitive with known industry standards?
- Do you have the accreditation necessary to maximize payor contracts and use of specialty medications?
- Are you missing opportunities to serve patients because you are not in a network?
If the answers to any of these questions give you pause, and leave room for improvement, partnering with an experienced pharmacy benefits manager, such as Maxor, can help. Here’s how:
- Support your goals to serve your entire patient population by managing FFS and MCO carve-in models, along with sliding fee schedules and uninsured programs
- Expertly navigate compliance requirements and regulations to ensure your pharmacy’s 340B accreditation—and forecast landscape changes on the horizon
- Build customized plans to help with favorable contracting and rate procurement
In order to streamline relationships with manufacturers, ensure the broadest range of access for your patient populations, and want to track medication adherence, covered entities can turn to an experienced pharmacy manager, such as Maxor, to help negotiate contracting on your behalf.