Home infusion providers continue to face growing challenges with PBMs and payors involving network access, reimbursement disputes, DIR fee pressures, audits, and increasingly complex credentialing requirements. Providers are navigating issues related to underpayments, restrictive specialty pharmacy networks, changing reimbursement methodologies, aggressive audit activity, and evolving state and federal protections impacting specialty and home infusion pharmacy operations.
In an article published in Specialty Pharmacy Continuum, Jesse Dresser discussed practical and legal strategies providers can use to protect their reimbursement rights and challenge improper payor conduct.
“My goal is to help independent providers navigate this very byzantine, vertically integrated space where payors are just as much competitors as they are the gatekeepers to getting into network.
Read the full article in Specialty Pharmacy Continuum (subscription required).
