A recent Pharmacy Practice News article highlights the ongoing challenges home infusion providers face when dealing with payors and pharmacy benefit managers (PBMs), including gaining network access, securing adequate reimbursement, and maintaining consistent payments. Complex network structures, evolving reimbursement models, and increased audit activity continue to create operational and financial pressures for providers, requiring a more proactive and informed approach to navigating payer relationships.
Frier Levitt partner Jesse Dresser emphasizes the importance of understanding the specific benefit structure governing each patient, as well as leveraging legal and regulatory tools to push back against PBMs and payors. He highlights practical strategies such as documenting claims thoroughly, invoking contractual dispute processes, and utilizing federal and state protections, including “any willing provider” laws and audit limitations. Providers who actively assert their rights and engage regulators when necessary are better positioned to protect revenue and remain competitive in an increasingly complex landscape.
Read the full article with Pharmacy Practice News.
