I’ve been ringing the alarm bell for several years now alerting the specialty pharmacy industry that it was under attack by health system owned specialty pharmacies. Many of my readers are sick of hearing that ‘the sky is falling’.
Today we are ready to say that a wall may have been hit. The article below details feedback from payers that they are now pushing back on health system owned specialty pharmacies.
Here are some payer comments—
A pharmacy is a pharmacy is a pharmacy.
They have the [same] ability to order a product.
They all have the [same] ability to dispense a product.
There is absolutely no difference between health-system specialty pharmacies and [independent] specialty pharmacies
Our [network] specialty pharmacy does everything a health-system pharmacy would do just as well.
There are “zero reasons” for health plans to work with hospital specialty pharmacies.
Now that’s different !
We believe that the incursion of health system owned specialty pharmacies has hit an inflection point. The largest health systems have used their prominence as ‘must have’ medical providers to bully their ways into payer pharmacy networks. Now that so many have been admitted to networks, payers are likely saying ‘enough is enough’.
So, is the danger to independent specialty pharmacies over?
No, not by a long shot.
As long as those big health system owned specialty pharmacies are in the payer networks they control a huge number of physicians that will write prescriptions that first get sent to the health systems’ pharmacies.
Health Systems Versus Payors: A Duel for SP Care
Dueling misperceptions among health plans and payors about the value each brings to patient care can make it difficult for them to forge effective partnerships, according to a recent survey by Trellis Rx.
To create the report, 60-minute blinded telephone interviews with 10 hospital pharmacy leaders (i.e., directors, vice presidents, chief or specialty pharmacy managers) and 10 health plan leaders (i.e., medical directors, pharmacy directors, directors of pharmacy contracting), as well as nine subject matter experts: industry consultants and health-system pharmacy executives.
Many of the responses underscored the wide gulf that exists…….. CLICK HERE TO ACCESS THE FULL ARTICLE
By Gina Shaw
Specialty Pharmacy Continuum