In the ever-evolving landscape of the pharmaceutical industry, pharmacies face numerous challenges in maximizing their revenue. One significant factor that impacts profitability is the complex world of Pharmacy Benefit Managers (PBMs). These intermediaries play a crucial role in determining reimbursement rates and managing prescription drug benefits for patients. In this blog, we will uncover some hidden PBM tips that can help pharmacies increase their revenue and navigate this intricate system more effectively.
1. Negotiate Favorable Contracts:
When dealing with PBMs, it is essential for pharmacies to negotiate contracts that are favorable to their financial interests. This includes ensuring fair reimbursement rates, transparent fee structures, and reasonable audit practices. By carefully reviewing and negotiating these contracts, pharmacies can secure better terms and improve their revenue streams.
2. Optimize Formulary Management:
PBMs maintain formularies, which are lists of preferred medications for specific conditions. Pharmacies can increase their revenue by actively managing their formulary status. QRx can regularly review and update the pharmacy reimbursement with an edit based on PBM's preferred drug list. By doing so, pharmacies can ensure a higher volume of prescriptions and better reimbursement rates.
3. Implement Medication Therapy Management (MTM) Services:
Offering MTM services can be a valuable revenue stream for pharmacies. These services involve comprehensive medication reviews, patient counseling, and personalized care plans. By providing MTM services, pharmacies can demonstrate their value in improving patient outcomes, leading to increased reimbursement rates and patient loyalty.
4. Opt for Direct and Specialty Pharmacy Networks:
Some PBMs offer direct and specialty pharmacy networks that allow pharmacies to bypass certain intermediaries and negotiate better reimbursement rates. Having Pre and Post Edits (PPE) in place allows the pharmacies to ensure the correct reimbursement when partnering with specialty networks. By joining these networks, pharmacies can access a broader patient base and potentially increase their revenue.
5. Leverage Technology Solutions:
Utilizing technology solutions can streamline pharmacy operations and improve revenue generation. Implementing electronic prior authorization (ePA) systems can reduce administrative burdens and expedite prescription processing, leading to increased efficiency and revenue. Additionally, leveraging QRx’s data analytics tools can help pharmacies identify trends, optimize inventory management, and make informed business decisions.
6. Stay Informed and Engage in Advocacy:
The PBM landscape is constantly evolving, with new regulations and policies being introduced regularly. QRx can provide pharmacies industry updates and solutions. Allowing pharmacies to actively engage in advocacy efforts to influence policy changes that benefit their financial interests. By participating in professional associations and collaborating with other stakeholders, pharmacies can have a stronger voice in shaping the future of the industry.
Navigating the complex world of PBMs can be challenging for pharmacies seeking to increase their revenue. By implementing these hidden PBM tips, pharmacies can optimize their contracts, formulary management, and service offerings to enhance their financial performance. Leveraging technology solutions and staying informed about industry changes will further empower pharmacies to thrive in this competitive landscape. With careful planning and strategic execution, pharmacies can unlock new revenue opportunities and ensure their long-term success. Contact QRx today and let us help grow your pharmacy business.
