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Two pharmacists reviewing a prescription, credentialing and compliance

Empowering Your Pharmacy: Quality Credentialing and Compliance Services

For many communities, the pharmacy is often the most accessible point of contact for a patient’s everyday health concerns. For many independent pharmacies, the ability to provide focused patient care is what keeps customers coming through the door. With the limited time pharmacies already have to care for patients, maintaining proper compliance and credentialing can be an additional burden. A PSAO can help streamline this process by offering services that alleviate these burdens and allow a pharmacy to keep its focus on the patient instead of performing time-consuming administrative tasks.

Pharmacies are required to have a policies and procedures manual for in-house staff to access any time. The Pharmacy Operations Manual should include a collection of state and federal best business practices to help your Pharmacy comply with various requirements, including State Boards and the DEA. While many pharmacies may not have the time to create their operations manual, a quality PSAO can provide you with a draft template that includes many of these practices to help simplify this process. Check with your PSAO and see if they provide this service.

Secure and accurate data retention is another basic requirement that pharmacies should have in place to remain compliant, especially when facing the potential for an audit. Quick access to a single repository for all pharmacy and staff credentials, including licensing documents, and OIG/SAM reports is essential. If your PSAO can’t provide you with 24/7 access to the information you need, you may get stuck waiting for access to information necessary to keep your daily operations running.

Beyond reporting and storage, regulatory agencies require pharmacies and their staff to undergo specific credentialing and training to maintain business and operating compliance. From pharmacist to technician, compliance training is essential to ensuring a pharmacy’s staff is appropriately trained in the handling of sensitive documents as well as controlled substances. Your PSAO should be able to assist you in providing the necessary training, including Fraud, Waste, and Abuse, and HIPAA Training, to keep your staff in compliance.

Rules and regulations from CMS, PBMs, and other governing bodies continue to evolve, requiring pharmacies and their staff to complete further training to serve their communities. As the patient population continues to diversify, some states are mandating additional training to ensure appropriate care is given to patients of all genders, sexualities, ethnicities, and religious beliefs. Many states also require retail pharmacies to provide additional training for handling and disposing of hazardous drugs within their business. If you partner with a PSAO, make sure they can provide you access to the most up-to-date training necessary for your pharmacy to operate within these requirements.

While compliance and credentialing requirements vary by state and region, not all PSAOs are flexible enough to provide you with the customized services you need. Many credentialing and compliance packages come bundled with programs that don’t cater to your needs or apply to your business – all while charging you a premium price. A PSAO should be a partner that supports your success, allowing you to select the services you need without requiring you to pay for ones you don’t. Pharmacy First can help answer any questions you may have when it comes to making sure your pharmacy receives the appropriate compliance and credentialing services. As the first and only PSAO to become a URAC-accredited CVO, we strive to go above and beyond as your credentialing partner in excellence.

About the Author

Craig’s pharmacy career began as a Pharmacy Technician in an independent pharmacy. After 5 years, Craig transitioned to the PBM industry, where he has spent the last 31 years in various leadership roles. Craig has developed and implemented major programs with various PBM’s, including performance-based programs to increase pharmacy payment.

pharmacist scrolling on a tablet computer managing programs

Empowering Your Pharmacy: Managing Programs and Profitability

A PSAO can provide immense value to a pharmacy needing back-office support. Most pharmacists utilize PSAO services to gain access to a large contract base, handle their contract negotiations, and manage and distribute their receivables. However, as pharmacies continue to be impacted by rising Direct and Indirect Remuneration (DIR) fees, steady changes in audit criteria, and overall lower profit margins, it is imperative that your PSAO can provide program solutions to ease these burdens.

It is easy to see why DIR fees are at the top of every pharmacist’s mind. In just a decade, the Center for Medicare & Medicaid Services (CMS) revealed that DIR fees have increased by over 90,000 percent! Pharmacies can become quickly overwhelmed with managing these fees, but a strong PSAO partner can provide you with solutions to ease these burdens. Many PSAOs partner with programs that can help decrease the back-end burden for pharmacists and make attacking DIR fees simpler. Quality monitoring programs like EQUIPP^® and OutcomesMTM allow your pharmacy to receive essential data that makes confronting DIR fees more straightforward. These services should be made available when your pharmacy would like to use them. However, they should never be forced onto your pharmacy or bundled into package pricing, as they are not for everyone. A good PSAO can not only educate your pharmacy on best practices for all platforms but also discern what programs are a good fit for your pharmacy.

The COVID pandemic has shifted how much of business is done today. Many tasks, including audits, have now become virtual. In 2020, many PBMs shifted to virtual audits, which according to PAAS National data, allowed for a 40% increase in reviewed prescriptions. It is becoming increasingly important for pharmacists to have an auditing process they are confident in. A good PSAO can provide you with in-house audit support that will help monitor your claims as well as guide you through the audit process. When it comes to audits on potentially hundreds of claims a day, automation is key, which is why a PSAO that can provide your store with Pre and Post Editing software is crucial to avoiding trivial audits.

As the frequency of audits and DIR fee hikes continue, pharmacies also continue facing challenges maintaining profitability. It was one of the most frequently discussed topics at the 2022 NCPA Annual Convention this year. A pharmacy’s profitability can no longer survive on billing medications alone. To thrive in today’s economy, a pharmacy must develop multiple revenue streams. Lectures from this year’s convention ranged from opportunities in pharmacogenomics, point-of-care testing, and hearing aids, to the cost-plus pharmacy model. Autofill programs and secondary packaging solutions such as Medicine-on-Time also have the ability to keep patients adherent to their medications. There are numerous ways your pharmacy can positively impact patient health while also generating profits and keeping the patient in the store. A good PSAO can discuss these opportunities with you and even provide you with resources to get your pharmacy started.

DIR fees regularly increase, audits are becoming more prevalent, and profit margins are lower than ever before. Owning a pharmacy can feel very difficult right now, so it is more important now than ever to ensure you are partnering with the right PSAO. Providing access to multiple programs, ensuring these programs are right for you, and strategizing while educating your team to make the most out of your additional services – this is what makes a good PSAO an excellent partner. Make sure when choosing a PSAO, that it puts your Pharmacy First.

About the Author

Dalton Thompson, PharmD, is the Senior Manager, Pharmacy Programs for Pharmacy First with almost 10 years of pharmacy experience. His experience began in retail pharmacy and his passion for helping patients within the healthcare system brought him to managed care. His past experience in the U.S. Air Force Reserves has instilled in him meticulous attention to detail when assisting patients and pharmacists alike.

Empowering Your Pharmacy: Analyzing Reports

Keeping up with all the communications and information from multiple payers is daunting. One of the most crucial pieces of information a pharmacy receives from the Pharmacy Benefit Managers (PBM) is the performance reports. Although frequently challenging to find and difficult to interpret, a pharmacy needs to understand gaps in clinical care that may impact contract performance. These reports provide crucial insight into the clinical metrics that drive DIR fees and program incentive payments throughout the year. Your best solution is to have a Pharmacy Service Administration Organization (PSAO) that can give you clarity and guide you through these reports.

Pharmacies rely on PBM reports to understand their performance metrics. However, PBM reports often vary in how they are distributed and formatted, making it difficult for pharmacies to identify essential information. Some payer reports may not include detailed adherence data for a pharmacy, creating difficulty in identifying areas of improvement for their daily operations. An experienced PSAO can help pharmacies locate reports and provide additional insight for analyzing their performance.

The phrase “Direct and Indirect Remuneration (DIR) fee” is frequently used in pharmacy reporting. A pharmacist would expect this term to be easily identified in a report used to determine the financial impact on their business. However, PBMs will often use their own specific terminology to identify DIR fees in their reports. DIR fees can be referred to as a Contingent Medication Adherence Performance Fee, a Network Variable Rate, or whatever the PBM calls it. Make sure you select a PSAO partner that helps you understand the contract terminology utilized by PBMs.

A pharmacy has located its reports and now understands the language within them. How do they interpret the data? Understanding the impact results have on a pharmacy is key to creating an action plan. Reports can be delivered in a basic spreadsheet-type grid or even a mess of colors and highlighted tables that use confusing metrics. Utilizing a PSAO with a dedicated on-staff performance team can provide pharmacies the additional help necessary to fully understand their reports. They can also assist in simplifying reporting metrics or even streamline calculation processes that reduce the legwork needed to identify potential financial impact.

Deciphering a DIR fee report loaded with adherence metrics is an achievement. However, being able to act on the report information is the only way to improve a pharmacy’s metrics. Creating an action plan with measurable solutions is the most integral step in understanding reports. Pharmacies want to create plans that will enhance their financial health while making the best use of their already limited time. Quality monitoring programs like EQUIPP^® and OutcomesMTM® provide streamlined platforms that can help pharmacies increase their quality metrics to help minimize their DIR fees and maximize their reimbursements. Make sure you partner with a PSAO that understands your goals and recommends the programs that best align with your business needs.

In today’s pharmacy landscape, it is not always enough for a PSAO to simply assist pharmacies in need. A dedicated PSAO will work to leverage the success of its high-performing member pharmacies to identify and share successful methods that benefit all pharmacies. By providing pharmacies with direct access to a contracting team and clinical pharmacist that can offer insight into payer reporting and analysis, Pharmacy First provides member pharmacies with the tools necessary to create an action plan for success. If your store would benefit from additional reporting assistance, please contact us today at info@pharmacyfirst.com to learn more about how Pharmacy First can help support your success.

About the Author

Dalton Thompson, PharmD, is the Manager, Pharmacy Programs for Pharmacy First with almost 10 years of pharmacy experience. His experience began in retail pharmacy and his passion for helping patients within the healthcare system brought him to managed care. His past experience in the U.S. Air Force Reserves has instilled in him meticulous attention to detail when assisting patients and pharmacists alike.

Empowering Your Pharmacy: Contract Assistance

Choosing a Pharmacy Service Administration Organization (PSAO) can be a stressful decision for pharmacies uncertain of what to expect. There are many things to consider, but one of the primary concerns most transitioning pharmacies have is what will their contracts look like? Contract assistance is one of the most invaluable services a PSAO can provide, and it should not stop once you finish the enrollment process and have joined your new network. A PSAO that is a valuable partner will continue to work with your pharmacy and strive to ensure your success. We recently asked pharmacists and pharmacy owners what assistance they see as most crucial for their PSAO to provide them when it comes to the world of contracts.

One of the primary concerns an independent pharmacy may have when switching PSAOs is “how will this affect my contracts” and “what will my new reimbursement rates be”? With the inherent lack of transparency built into these agreements, it is difficult to assess what this variance will be. There can even be significant differences between payer contracts within your PSAO since all PBMs handle their reimbursements and remuneration fees inconsistently. It is important to find a PSAO that has your pharmacy’s interest in mind by being as transparent as possible and working to figure out if their contracts will be the best fit for your pharmacy.

Even with transparency, it can still be difficult to discern all the nuances between the available contracts. A valuable PSAO should provide your pharmacy with an adept resource that can communicate key terms in contracts and determine where you can see the most financial benefit. A specialized contracting team that is available to provide transparent information in a concise format to their audience is an invaluable service that your PSAO should offer.

All payer agreements come with their nuances, but they will all have the same key elements your PSAO should focus on – especially for your Medicare Part D patient population, as they are tied to Star Ratings. The major components of Part D agreements that impact pharmacies most are the reimbursement models and direct remuneration (DIR) fee structures. These tend to be the primary focus for pharmacies. However, it is still important to incorporate the payer’s DIR fee into all reimbursement models.

Some contracts are often misleading, providing attractive reimbursement rates but at the cost of a significantly higher DIR fee to be assessed in a separate manner or timeframe. Understanding the timeframe for reimbursements and DIR fee structure can be essential to a successful pharmacy. It is vital to know what your pharmacy will earn at the point of sale, while proactively assessing what DIR fees could be accruing in the background if not taken at the point of sale. A PSAO that can provide you with an escrow process for your business can significantly help offset the variance and uncertainty these fees bring to your business.

Managing payer agreements while juggling the myriad of tasks required to keep your pharmacy running can feel daunting. The purpose of a PSAO is to provide administrative support to a pharmacy, allowing them to focus on their intended purpose – to effectively serve and treat their patient community. When selecting a PSAO, make sure you choose a partner that helps you navigate these agreements and can also empower you with the knowledge and tools you need to best serve your community.

Pharmacy First strives to be your partner in excellence by supporting your success in every way possible. Our in-house contracting team and on-staff pharmacist are available to answer your questions with transparency and clarity. In addition, we provide in-house escrow services to protect your pharmacy from the burden of additional DIR fees. Contact us today at info@pharmacyfirst.com to learn more about our PSAO.