Challenges with pharmacy-hospice direct contracting
Pharmacies face significant challenges when contracting directly with hospices. Some of these include:
2 min read
Kate Schaddelee
:
Jan 3, 2023 10:00:00 AM
When it comes to attaining 5-star ratings, there are several reasons your PBM may not be aligned with your goals like you think they are. Read below to learn how your PBM may actually be working against you.
Here are the top 10 ways your PBM isn’t aligned with 5-star ratings.
Drugs for Per Diem contracts are typically chosen based on what will be most profitable for the PBM. If a medication that is in your current formulary goes up in price, there is a risk that the medication may be taken off the Per Diem formulary.
Per Diem formularies are rigid and controlled by the PBM, not the hospice. There is a penalty for using off-formulary medications (i.e., higher medication costs for the hospices).
PBMs are not focused on reviewing or reducing the costs of medications for hospices. They are focused on what benefits them most in Per Diem contracts.
“Free” services increase per diem rates. Hospices often are unaware they pay extra for additional services (ex., pharmacist consultations & delivery fees) that are not included in the Per Diem.
Per diem contracts are developed to benefit the PBM, not the patient or the hospice. If a patient requests a preferred medication, it is not typically not taken into account.
Per diem contracts can cause more work for nurses. They are often left with the task of researching patients’ medications so they can convert them to something approved on the formulary.
See above in ‘More work for nurses’.
See above in ‘More work for nurses’.
PBMs are not as focused on providing nurses the tools for success when explaining to patients why certain medications can not be ordered. (i.e., medications not being included in the hospice formularies.)
Per Diems are a one-size-fits-all approach to medication management. They typically do not take into account the individuality of the patient and what might be best for their situation.
Book a discovery call here to discuss the challenges unique to your hospice or get in touch with one of our specialists today!
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Pharmacies face significant challenges when contracting directly with hospices. Some of these include:
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