As the specialty pharmacy industry has expanded, payers and pharmacy benefit managers (PBMs) have adopted a range of tactics for contracting with specialty pharmacies. From “closed” networks to more stringent credentialing requirements, today’s specialty pharmacies face an intricate web of contracting choices and challenges.
Innovatix Credentialing Counsel is our new solution for specialty pharmacies facing payer credentialing challenges. As part of our suite of pharmacy operations improvement programs, this service provides guidance for each task in the credentialing process for specialty pharmacies and helps users navigate the evolving payer landscape.
What is credentialing?
Payers, PBMs, and health plans evaluate pharmacies with which they contract to confirm which services they’re able to provide and that they have adequate training, certification, and/or licensing to provide them. The credentialing process establishes a pharmacy’s qualifications, confirms its good standing with applicable state and federal laws, and ensures it meets quality performance standards.
Meeting credentialing requirements involves an investment of time and money. Credentialing requirements for specialty pharmacies may include:
- Proof of accreditation from either ACHC, URAC, or the Joint Commission;
- Higher insurance coverage;
- Detailed reporting of all specialty medications dispensed within 12 months (by therapy class and AWP volume);
- A business continuity and/or disaster recovery plan; and
- Policies and procedures confirming access and communication.
Support based on your needs and resources
Innovatix offers specialty pharmacies two levels of support to best meet each client’s needs.
In a LEVEL ONE engagement, Innovatix provides the following services:
- Pharmacy assessment
- Credentialing education
- Application guidance
- Document collection
- Weekly or monthly touchpoints
- Application submission
- Simulated onsite review
A LEVEL TWO engagement is more comprehensive, with Innovatix experts providing two services in addition to the ones listed above:
- Policy creation
- Full access to the Innovatix Accreditation Advisory Services program, which supports pharmacies seeking recognition from various accrediting bodies
Innovatix Credentialing Counsel is a fee-for-service program that is open to any pharmacy nationwide that’s currently in or seeking to enter the specialty space, regardless of membership in the Innovatix GPO. Fees are per facility, based on hourly rates and level of engagement. Innovatix fees do not include credentialing charges that must be paid to PBMs or other payers.