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Specialty Pharmacy Mandates Hurt Healthcare Providers

National Infusion Center Association

Specialty pharmacy mandates create administrative burdens on providers and pose serious risks to patients. Healthcare providers should be focused on providing the best care for their patients, but a specialty pharmacy mandate makes that task an increasingly difficult, often insurmountable one. If you are worried about BlueCross BlueShield of Tennessee’s specialty pharmacy mandate and how it will affect your ability to treat your patients and their ability to manage disease, we encourage you to send a letter sharing your concerns.

The following template is a general letter, but we encourage you to customize it. Sharing your story and/or explaining how this will directly affect your practice will help your letter have a greater impact. Below are some talking points for both patients and providers.

 

Talking Points for Healthcare Providers:

The hidden costs and waste associated with sourcing infusion drugs from specialty pharmacy can make this model unsustainable.

  • The provider’s office, not the insurance company, shoulders the serious risks associated with the administration of biologics. Pre- administration, administration, and post-administration aspects of administering specialty medications are extremely involved and can require up to 2 to 3 hours of additional labor. Under a specialty pharmacy mandate, providers will still be required to complete these important safety steps, but would not receive proper reimbursement. If it is no longer financially viable to treat a patient, providers will be forced to send their patients to other settings, like a hospital, and increased costs for both the patients and BCBS TN.
  • Specialty pharmacies can present issues relating to drug quantities or volume, and drug wastage. Offices can sometimes receive different quantities that what is ordered or experience shipping delays, which could delay treatment for patients, causing serious health implications.

There will be great risk to patients’ health outcomes under this mandated specialty pharmacy acquisition.

  • Providers rely heavily on appropriate reimbursement for our services in order for your care model to be sustainable. If you lose these drug payments with this proposed specialty pharmacy acquisition model, the financial viability of your care setting would be seriously jeopardized, possibly forcing you to discontinue treating BCBS TN patients. 

There will be a significant increase in administrative burden on providers that will result from restricted access to affordable drugs.

  • Removing an office’s ability to buy-and-bill medications through the implementation of mandatory specialty pharmacy requirements will limit our ability as providers to continue delivering consistent, high-quality care in a safe environment at a cost significantly lower than hospital care settings. Under the current reimbursement structure for professional services associated with delivering provider-administered medications, loss of drug payments could make the non-hospital, office-based infusion/injection model financially unsustainable.

 

Have you, your office, or your patient been affected by a specialty pharmacy mandate? Email your story to advocacy@infusioncenter.org.

 

The National Infusion Center Association partnered with the National Organization of Rheumatology Managers (NORM) to author a letter of concern to BlueCross BlueShield of Tennessee in December 2019. To view our letter, visit infusioncenter.org/BCBSTN2019.

Specialty Pharmacy Mandates Hurt Healthcare Providers

National Infusion Center Association

Specialty pharmacy mandates create administrative burdens on providers and pose serious risks to patients. Healthcare providers should be focused on providing the best care for their patients, but a specialty pharmacy mandate makes that task an increasingly difficult, often insurmountable one. If you are worried about BlueCross BlueShield of Tennessee’s specialty pharmacy mandate and how it will affect your ability to treat your patients and their ability to manage disease, we encourage you to send a letter sharing your concerns.

The following template is a general letter, but we encourage you to customize it. Sharing your story and/or explaining how this will directly affect your practice will help your letter have a greater impact. Below are some talking points for both patients and providers.

 

Talking Points for Healthcare Providers:

The hidden costs and waste associated with sourcing infusion drugs from specialty pharmacy can make this model unsustainable.

  • The provider’s office, not the insurance company, shoulders the serious risks associated with the administration of biologics. Pre- administration, administration, and post-administration aspects of administering specialty medications are extremely involved and can require up to 2 to 3 hours of additional labor. Under a specialty pharmacy mandate, providers will still be required to complete these important safety steps, but would not receive proper reimbursement. If it is no longer financially viable to treat a patient, providers will be forced to send their patients to other settings, like a hospital, and increased costs for both the patients and BCBS TN.
  • Specialty pharmacies can present issues relating to drug quantities or volume, and drug wastage. Offices can sometimes receive different quantities that what is ordered or experience shipping delays, which could delay treatment for patients, causing serious health implications.

There will be great risk to patients’ health outcomes under this mandated specialty pharmacy acquisition.

  • Providers rely heavily on appropriate reimbursement for our services in order for your care model to be sustainable. If you lose these drug payments with this proposed specialty pharmacy acquisition model, the financial viability of your care setting would be seriously jeopardized, possibly forcing you to discontinue treating BCBS TN patients. 

There will be a significant increase in administrative burden on providers that will result from restricted access to affordable drugs.

  • Removing an office’s ability to buy-and-bill medications through the implementation of mandatory specialty pharmacy requirements will limit our ability as providers to continue delivering consistent, high-quality care in a safe environment at a cost significantly lower than hospital care settings. Under the current reimbursement structure for professional services associated with delivering provider-administered medications, loss of drug payments could make the non-hospital, office-based infusion/injection model financially unsustainable.

 

Have you, your office, or your patient been affected by a specialty pharmacy mandate? Email your story to advocacy@infusioncenter.org.

 

The National Infusion Center Association partnered with the National Organization of Rheumatology Managers (NORM) to author a letter of concern to BlueCross BlueShield of Tennessee in December 2019. To view our letter, visit infusioncenter.org/BCBSTN2019.