ProxsysRx helps 340B hospitals create a glide path for financing onsite specialty pharmacies at little to no risk.
We also take the most time-consuming administrative burdens involved off the health systems, navigating them through the challenges of getting their specialty pharmacies up, running and successful. We get to know your doctors, your clinicians and your patients — so we can tailor your specialty pharmacy to the needs of your patients, and the difficult disease states that they need to manage.
Owning a successful 340B specialty pharmacy starts with optimizing your 340B program
The first, and most important, step we take in planning a successful onsite specialty pharmacy is to ensure that the clinics writing the most specialty prescriptions in your system are eligible and registered with your 340B program.
Establishing your 340B specialty network
When developing a specialty pharmacy tailored to your covered entity’s needs, we consider the following:
340B qualification rule sets
We’ll help you do the following:
• Work with your third-party administrator (TPA) to identify your high-volume specialty prescribers.
• Extend eligible-date windows to account for longer timelines associated with prior authorizations and medical benefit eligibility checks.
• Ensure that your prescribers are adhering to your defined workflows, and meeting all charting requirements.
• Make sure your qualifications account for all delivery-channels through which prescriptions are sent to your specialty pharmacy — including fax, EMR and pharmacy hub.
Starting a Specialty Pharmacy: What does the process look like?
Specialty pharmacies require accreditation that’s costly, both monetarily and in terms of the time involved to get it. We’ll help you 1) Contract with payers, and 2) Provide the necessary data and analytics to PBMs and manufacturers, to prove to them you’ll be providing the level of quality patient care that’s expected of Specialty Pharmacies.
We seek inclusion from all PBMs in a health system’s area.
Internal operations are only part of the formula for a specialty pharmacy’s success. We go in-network, securing cooperation and approval from all the major local insurers, for the PBMs that their patients are covered by. What’s more, we seek access from the drug manufacturers for what they’re prescribings.
We also guide you through the process of stocking and staffing your specialty pharmacy — as well as aligning all practices, policies and procedures for accreditation.
Paying for your own specialty pharmacy
By helping hospitals improve their 340B programs’ revenues, then implement strategies for funding specialty pharmacies from that improved revenue, the goal is that the hospitals ultimately pay nothing out of pocket to build and manage their own specialty pharmacies.
Altogether, ProxsysRx has generated more than $435 million in 340B revenue for the health systems we serve — and yes, we’ve even managed to work successfully with 340B ESP and other manufacturer restrictions.
Use your hospital’s retail pharmacy to build a specialty pharmacy
A well-managed retail / outpatient pharmacy can, and should, generate significant revenue and profits for your health system. ProxsysRx currently owns or manages 22 in-house retail / outpatient pharmacies, and — on average — those pharmacies generate $750 to $1000 in net profit per bed, per month. Which means, for instance, that a 200-bed hospital can expect to generate $150,000 to $200,000 in monthly net profit from its in-house retail pharmacy.
Serving 340B hospitals as their retail pharmacy partner
If you choose ProxsysRx to build-and-own or manage your retail pharmacy, we take the responsibility for generating revenue at our own risk. Which means our clients are never exposed to even the potential for loss.
ProxsysRx is here to help, if you have questions.
This article offers just a brief overview of the process for building an onsite specialty pharmacy. For more information on how we can help your health system build and fund a specialty pharmacy, visit our website.
Or contact Howard Hall. C: 205.588.0946 | firstname.lastname@example.org