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Why your pharmacy's direct hospice business might not withstand PBM poaching

By Mark Pilkington, MS, RPh

How PBMs are winning hospice business — and what you can do about it

Hospice administrators naturally want to connect with pharmacies that can best serve their patients. Sometimes, they may mistakenly believe that a pharmacy benefit manager (PBM) is the best way for them to receive a rich level of support. But PBMs can't always provide the local access that a hospice needs. As an independent pharmacy owner, you know that. But are you sure your hospice accounts know that?

Consider these four reasons your direct hospice business might not be safe from a PBM:

1. Hospice agencies may need more services than one pharmacy can offer

Hospice administrators often need extensive services from their pharmacies, such as access to claims data down to the patient and prescription level. They generally rely on their pharmacy vendor to support drug utilization management and reporting to the Federal government. Hospices also look for providers who can manage multiple pharmacies within a geographic network.

Keep your hospice business safe by considering a contracting partner that can help you access local hospice business and deliver the same level of service as a PBM. Some of these services include centralized CMS data reporting, a portable e-prescribing tool, and a flexible, standardized drug list. While PBM's offer extensive services, hospices may not realize how limited their access to local pharmacies might actually be.

2. PBMs perpetuate a myth around local care

One of the ways PBMs win hospice business is by selling the idea that they offer the same local control as a local pharmacy. In truth, the only way major PBMs can succeed is if they have relationships with local pharmacies, too. Most of the larger PBMs use a mail-order model for delivering medications, but this doesn't work, for example, when a new hospice patient needs same-day delivery. And while some PBMs may try to partner with local pharmacies to fill that gap, the financial terms may not work in favor of the independent pharmacy.

Keep your hospice business safe by joining forces with other independents to provide hospices with access to an extensive network of local pharmacies that PBMs may lack. This can provide savings to the hospice agency and fair reimbursement to the pharmacy.

3. If they can't offer it, they'll undervalue it

Many independent pharmacies offer a hands-on approach that reaches beyond what PBMs provide, whether it's being on-call 24/7 for emergencies or caring for the whole patient rather than just writing prescriptions. Having a relationship with a local independent pharmacy means having access to personalized services beyond what a PBM can offer. That's why a PBM looking to win hospice business might highlight perceived savings or data management over their ability to care for patients.

Some contracting partners that work with hospices require the pharmacies in their network to offer these types of services so they can ensure the highest level of care. Pharmacies are asked to take care of the patients, provide clinical services and/or special packaging, and be available 24/7.

Keep your hospice business safe by making sure your special place in your community shines. You'll be better equipped to communicate the unmatched level of care you can deliver to hospice agencies and partners who can include you in hospice networks.

4. Perception is reality when it comes to pricing

When a PBM comes along with the promise of prescription efficiency and reduced administrative burden for the clinical staff at a hospice, the pricing model may seem fair to the hospice customer.

Unfortunately, this process often lacks transparency and can lead to higher prices overall and lower payouts for local pharmacies. What hospice agencies don't see in PBM pricing is spread details that hold back full reimbursement from their independent pharmacy partners in local communities. They also may not know they have the option of partnering with a network of independents.

Keep your hospice business safe by converting your direct hospice business to a network partnership that can save hospice agencies 20 to 40 percent over their competitors, while offering fairness in pricing and transparency to both the hospice and the pharmacy. It's a way to leverage the wraparound services and efficiencies of a PBM with the local services and community relationships of an independent pharmacy.

Learn more

Worried about PBMs poaching your business?

If competing with PBMs still feels overwhelming, Hospice Pharmacy Connect can help. Hospice Pharmacy Connect is the only hospice provider that has close, trusting relationships with local independent pharmacies while competing on the same level as PBMs.

About The Author

Mark Pilkington, MS, RPh

Vice President, Managed Care
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