More PBMs Moving to Compound-Specific Credentialing Processes In Effort to Demonstrate Protection Against Repetition of NECC

At the urging of Plan Sponsors, more and more Pharmacy Benefits Managers (PBMs) have begun designing and implementing compound-specific credentialing processes and compound-specific networks. This first major PBM to unroll this new model was Express Scripts, who in late 2013, early 2014 began requesting that certain compounding pharmacies complete a new, enhanced online recredentialing questionnaire, which asked many new and pointed questions regarding the pharmacy’s compounding and billing practices, as well as the pharmacy’s business structure. This month, two other PBMs have either begun a similar enhanced compounding credentialing process or indicated that they would be rolling one out soon. 

We believe that this trend will continue, with more and more PBMs coming under pressure from their Plan Sponsor customers to demonstrate what they are doing to guard against an NECC repeat. However, one of the chief difficulties with implementing and administrating this process is manpower, and already, the credentialing process can take weeks, even months, to fully complete the review of a pharmacy. In light of this, it is important for compounding pharmacies to be prepared and to bring their practices in line with the requirements under each PBM’s manual.

Frier Levitt can assist pharmacies in completing these very robust applications and can advise clients on compliance with the updated Manuals as well as State and Federal laws and regulations. Frier Levitt can help your pharmacy navigate these important application processes for a flat fee, affording  substantial savings off our hourly rates. If you’ve received a compounding-specific recredentialing request or have more questions, contact Frier Levitt.

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