Frier Levitt partner Jesse Dresser is featured in Specialty Pharmacy Continuum, discussing strategies home infusion providers may consider when addressing reimbursement, network access, and challenges posed by payors and pharmacy benefit managers (PBMs).
The article examines how home infusion providers are navigating a complex reimbursement landscape that spans both medical and pharmacy benefits, including network participation barriers, claim denials and underpayments, and PBM practices that steer prescriptions toward affiliated specialty pharmacies—issues that can affect both patient access and provider revenue.
In discussing potential response strategies, Jesse notes the role of dispute mechanisms and enforcement tools available to providers, stating:
“Consider using arbitration and appeals to force the PBMs to the table, to at least have a discussion about rates and potentially explore where there could be claims.”
The article also addresses approaches such as contract negotiation, appeals of denied claims, reliance on statutory protections including any willing provider laws, and provider-focused advocacy, highlighting options available under state and federal law.
