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Click here to see the original post and comments from September Inproviders will continue to create the next wave of specialty pharmacies. Expect a volatile for the specialty pharmacy industry.
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Inabout 1 in 11 hospitals had a specialty pharmacy. However, nearly half of the largest hospitals operated a specialty pharmacy. Pharmaceutical manufacturers and pharmacy benefit managers PBMs should be wary of the expansion in hospital-owned specialty pharmacies.
Provide more integrated, comprehensive care for patients with complex, chronic conditions that are typically treated with specialty medications.
Integrate specialty pharmacy services with Accountable Care Organizations ACOswhich coordinate care across different providers. Some health systems are engaging in risk-based contracting with third-party payers, thereby providing incentives for high levels of patient monitoring and adherence services.
Generate substantial profits by acquiring discounted specialty drugs under the booming B Drug Pricing Program. More on this subject below.
In the following chart, the ASHP data show that many hospitals now have their own full-service specialty pharmacy. Larger hospitals were much more likely to have a specialty pharmacy than were smaller hospitals. Providers now account for one in five accredited specialty pharmacy locations.
For most of the recently-launched specialty drugs, manufacturers typically limit and manage the specialty pharmacies eligible to dispense these expensive medications. Manufacturers select pharmacies with the distinctive capabilities to serve patients, providers, and payers efficiently and effectively.
These networks typically include 5 to 20 specialty pharmacies. However, manufacturers will find it very difficult to say no whenever a hospital pharmacy asks to be part of the network.
An increasing number of physicians work for hospitals. See data in Physician Practice Acquisition Study: Anyone familiar with health economics research knows the sobering reality: Health plans and employers may force their PBMs to accept these mandates.
Hospitals are trying to increase revenues and reduce internal benefit costs by steering hospital employees to in-house pharmacies. Health plans accurately perceive hospitals as offering the least competitive pricing for specialty drugs.
Does anyone believe that hospitals will change their behavior with specialty pharmacies? However, PBMs and health plans often limit the number of specialty pharmacies available to a beneficiary.
To gain network access, hospitals can offer to fill prescriptions for drugs subject to B pricing. Such a structure effectively splits the value of the B Drug Pricing Program between a covered entity and a commercial health plan or a PBM.
In my opinion, such arrangements are a blatant abuse of the B program.Download a blank fillable Form w - Made By Petroleum Wholesalers For Hsca Taxed Purchases in PDF format just by clicking the "DOWNLOAD PDF" button.
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