What Do You Look For In A Hospice PBM?

What Do You Look For In A Hospice PBM?

Medication management is a crucial component of hospice care for patients. Over ten medications are given to hospice patients on average each day, which can be very expensive for both patients and hospice organizations. Pharmacy benefit management firms, which act as a bridge between hospice groups and pharmacies that supply patients with drugs, were required because of these escalating expenses. The use of a pharmaceutical benefits manager will enhance patient care and hospice operational effectiveness.

Pharmacy Benefit Manager

Third-party businesses known as pharmacy benefit managers (PBMs) oversee prescription drug benefits for health insurers. PBMs are viewed as consumer advocates for healthcare systems, aiming to reduce and control the cost of prescription drugs while streamlining the drug claims process. They can directly mail medication to patients and act as a hub for their prescription medication, prioritizing value-based care through efficient care coordination.

Role of Hospice PBM

Hospice aims to make patients as comfortable as possible by treating their pain and other terminal illness symptoms. It is understandable that pharmacists play a significant role in care delivery given the importance of medication therapy to that objective. The hospice pharmacy benefit manager, or PBM, performs the same. In the larger healthcare sector, a PBM’s main duty is to accumulate benefits and reimburse pharmacies for the dispensing of prescription drugs. Additionally, they negotiate prices with pharmaceutical firms and maintain formularies to control prescription expenses.

Hospices frequently rely on PBMs as well as other pharmaceutical providers with a focus on hospice since they have particular needs. The history of Enclara Pharmacia may be traced back to one of the earliest pharmacies and Hospice PBM service provider to focus solely on the hospice market. Pharmacy benefit management has become a big feature in the hospice industry over the last 15 to 20 years and is a fact in the healthcare industry. Hospices must pay for all medications related to a hospice diagnosis, making the negotiation and purchasing power offered by a PBM even more important.

PBMs provide hospice organizations with the pharmaceutical knowledge they need in conjunction with their buying power. According to hospice rules, each patient’s prescription plan must be overseen by a pharmacist, who is typically not offered by a local pharmacy provider and who can be challenging to work with without the interface abilities a PBM provides. Hospice organizations can also access pharmaceutical data by client, diagnosis, or day with a PBM for reporting and analysis. Additionally, hospice PBMs provide key education and support services, including as round-the-clock help (essential for hospice clinicians), crisis or comfort kits, online nurse portals, and even nurse CEUs.

How PBM’S Are Gaining Business with Hospice

Administrators of hospices will inevitably seek out pharmacies that can provide the greatest care for their patients. They could erroneously think that a pharmacy benefit manager (PBM) is the greatest approach for them to get a wealth of support at times. However, PBMs aren’t always able to give hospices the local access they require. You understand that because you own an independent drugstore. However, are you certain that your hospice accounts are aware of that? Think about these THREE reasons why a PBM could threaten your direct hospice business:

  • Hospice organizations might require more services than a single pharmacy can provide.

Hospice administrators frequently require a wide range of services from their pharmacies, including access to claims information down to the patient and medication level. To facilitate drug utilization tracking and monitoring to the federal government, they typically rely on the pharmacy vendor. Hospices seek out professionals who have experience running numerous pharmacies within a given geographic area.

Consider a contractual partner who can assist you in accessing neighborhood hospice businesses and providing the same caliber of service as a PBM to safeguard your hospice business. A portable e-prescribing tool, centralized CMS data reporting, and a customizable, standardized prescription list are a few of these offerings.

  • PBMs spread false information about local care

Selling the illusion that they provide the same local autonomy as a local pharmacy is one method PBMs attract hospice clients. In reality, major PBMs can only be successful if they have connections to neighborhood pharmacies as well. The majority of the bigger PBMs distribute prescriptions via mail order, however, this is problematic in some situations, including when a new terminal patient requires same-day delivery. In addition, while some PBMs would attempt to collaborate with neighborhood pharmacies to fill the gap, the financial arrangements might not be to the independent pharmacy’s advantage.

Join other independent voters to give hospices access to a vast network of neighborhood pharmacies that PBMs might lack in order to protect your hospice business. The hospice agency may save money as a result, and the pharmacy may receive just compensation.

  • They will undervalue it if they cannot provide it.

Many independent pharmacies provide a more hands-on approach than PBMs do, whether it is by being available around the clock for emergencies or by treating the full patient rather than just issuing prescriptions. Having a connection with a neighborhood independent pharmacy gives you access to specialized services that exceed what a PBM can provide. Because of this, a PBM vying for hospice business may emphasize apparent saving or data administration over patient care.

What Does A PBM For Hospice Do?

Each hospice PBM provides a distinct combination of services. They can be divided into the following groups:

  • Access to medications
  • Utilization control
  • Pharmacological advice
  • Regulatory compliance
  • Workflow improvement

Choosing PBM

Cost is obviously an important consideration when choosing a PBM, but from a purely financial standpoint, many of the largest terminal PBM players will be comparable. Make careful to compare the per diem vs. per drug rate alternatives offered by the PBM. Making sure that your EMR system can interact with the chosen PBM is a crucial factor for hospices to take into account when choosing a PBM. Verify that both the PBM and EMR suppliers are ready to link their systems for your agency’s benefit. Linking the systems will eliminate double entry of patient information and reduce prescription errors by allowing seamless data transfer from the EMR platform to the PBM. It can also spare nurses numerous hours of work.

Read Also: What Is Long-Term Care Pharmacy?

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