As sophisticated providers of patient care, many health systems are integrating pharmacy services into their operations — investing in facilities, systems and staff strategically positioned to enhance specialty and primary care. To support this critical role, managed care staff negotiate with health plans and PBMs for inclusion in preferred provider and pharmacy networks. These negotiations are complicated by PBMs’ desire to steer patients — and revenues — to their own specialty and mail-order pharmacies.
As self-insured employers, health systems rely on health plans and PBMs for third-party administration and access to provider networks that meet the needs of employees and their families. Ironically, the networks they’re offered often exclude their own providers and facilities.
Unfortunately, smaller health systems simply don’t have the clout to force their way into the networks that will care for their own employees, while larger systems sometimes lack the knowledge and confidence to prevail.
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Robust TransparencyAll rebates, dispensing fees, interest on rebates and discounts are passed through, so that the only fee health systems pay is a management fee and a prior authorization fee.
Pharmacy Resource OptimizationPrescriptions are incented to flow through health system owned/affiliated pharmacies first.
Clinical CollaborationAlluma clinical pharmacists collaborate with health systems pharmacists, prescribers and medical plans to develop and implement effective strategies for the plan and its members.
Insights and IntelligenceMore value and savings will be proactively realized as the coalition grows exponentially.
