Trends in Payor Contracting Strategies for Specialty Pharmacies



As the specialty pharmacy industry has exploded, payors and Pharmacy Benefits Managers (PBMs) have adopted a variety of different tactics and strategies for contracting with specialty pharmacies. From “closed” networks to tiered admission criteria, specialty pharmacies face a veritable labyrinth when seeking to contract with payors and PBMs. This webinar will cover different network designs used by payors, trends in credentialing procedures, and medical-benefit versus pharmacy benefit reimbursement.

In this recorded webinar presentation, Jesse Dresser, Esq., demonstrates how today’s specialty pharmacies can gain entry into even the most restrictive specialty pharmacy networks.

This presentation explores:

  • The different strategies used by PBMs in contracting with specialty pharmacies and general trends of the industry
  • The difference between the medical benefit vs. pharmacy benefit reimbursement and how it impacts specialty pharmacy network access
  • What PBMs and payers are looking for in today’s specialty pharmacies
  • Why closed or restricted specialty pharmacy networks exist and how to enter

If your pharmacy needs help gaining access to a network or are having network issues, contact Frier Levitt to speak to an attorney. 

Download the presentation slides.

This webinar is presented through a partnership with Mediware.


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