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.