According to a report in Drug Channels, payors are implementing solutions to reduce cost on Specialty Drugs.
These medications are high cost and require special equipment with a dedicated area to prepare these drugs under strict supervision.
This payor controlled model "buy and bill" has financial implications for existing contracts for physicians and Infusion pharmacies supplying these drug and billing the payor.
As with all things Rx related, PBM's have or will have a hand in these contracts with IV suppliers, adding competitive pricing into the picture. There have been a number of discussions about Limited networks(deleted mostly) on this board, and its growth, this is now entering Infusion Centers and Hospital Pharmacies control over Drug pricing/costs. This new model by Insurance providers/Payors and their PBM's will cause downward adjustments to revenue projections from most of the Specialty Prescription providers as costs reduction efforts are implemented.
Several large PBM's have there own Specialty pharmacies and may become the beneficiary of these new programs.