Being part of a Pharmacy Services Administrative Organization (PSAO) comes with a number of benefits to participating pharmacies. A PSAO provides the opportunity to contract with a larger number of plans than an individual pharmacy would be able to on its own. It also provides access to preferred networks for certain plans. These preferred networks can lead to lower copays for patients and help increase a pharmacy’s script count and prescription revenue. Plus, pharmacies may enjoy some advantages if they are in a high-performing network. Apart from these benefits, many offer support with administrative aspects of contracting that can be confusing and time consuming.
As a pharmacy owner, you’re probably already well aware of these benefits and are part of a PSAO. Sometimes, however, you may find that you need to switch to a different organization. Before you make the leap, here are a few things to keep in mind:
1. Contract strategy:
When considering a new PSAO, ensure its contract strategy matches your patient demographics. For instance, if you serve a large dual eligible population, a PSAO with a non-preferred strategy would align well with your patient base. Check out this chart for more information on preferred pharmacy status of different PSAOs.
2. Services provided:
PSAOs offer a broad range of services but vary in how they provide them. Some of these services include reconciliation to identify claims that have been paid incorrectly, data analytics to identify key business drivers, and clinical tools to improve patient outcomes. Depending on the PSAO, some of these services come bundled and included in a monthly fee or are charged as an additional fee. Identifying the PSAO whose services — beyond contracting — best meet your needs and allow you to operate as efficiently as possible cannot be overlooked.
3. Adjustments:
DIR fees and GER fees are a reality of operating a pharmacy. As you consider a new PSAO, keep in mind that your current organization may hold funds in anticipation of retroactive fees such as DIRs and GER adjustments. It’s important to have sufficient cash flow to tide you over during your transition period.
4. CMS updates:
Be aware that CMS can take up to 90 days to update your preferred status on its plan finder once you make the switch. If your pharmacy conducts plan comparisons for your patients during the Medicare Annual Enrollment Period (AEP), it’s important to have your new PSAO start date by early August.
The process of changing your PSAO requires you to think ahead and plan appropriately, and there are a few ways EnlivenHealth can help. If you’re unable to complete the switch to a new PSAO before the AEP, your plan information can easily be customized in EnlivenHealth’s Medicare Match within 24 hours. This will enable you to complete accurate plan comparisons for your patients. Additionally, EnlivenHealth can help you maximize opportunities to increase your non-prescription revenue and your cash flow. To learn more about any of these opportunities, don’t hesitate to reach out.