“Once you’ve wrestled (with the big 3), everything else in life is easy.”

The quote I modified above is from Dan Gable, the Michael Jordan of wrestling. Gable, is the retired head coach of the University of Iowa wrestling where he won 15 NCAA titles and as a collegiate wrestler at Iowa State, Gable lost only 1 match and won gold in Munich in ’72 while only giving up one point.  The theme is that wrestling makes you tough and that nothing in life is as hard as wrestling.

The same goes for wrestling with Express Scripts, CVS Heath and OptumRX. Hospital Systems have to get into great shape, train with a team and have a clear game plan to out hustle, outwit and out execute the big three. Last week a hospital system in the mid-west said that they would just contract their Specialty Pharmacy. This is the equivalent of asking someone else to do pushups for you. They get all the benefit and you, the hospital system, get nothing. Contract pharmacies are not a hospitals’ friend for Specialty Pharmacy. They are very profitable scavengers that prey on hospital systems that are looking to provide better care through their pharmacy.

Waterfall

This illustration is one of the best I have seen at explaining why Contract Pharmacies don’t return any value back to the hospital.  Exclude Medicaid, Managed Medicaid, 340B savings on LDDs, most payors, most LDD drugs, don’t forget to take out the dispensing fee and 20% Contract Pharmacy Fee and hospital systems are left with very little. There is also no way that a contract pharmacy can help the hospital with care.  Huge promises from contract Pharmacies abound. All those promises all amount to a call center with robo calls. 3 Levers That Separate Good from GREAT in Hospital-Owned Specialty Pharmacy details how Specialty Pharmacy requires a fit organization. No one other than YOU, the hospital system, can do the pushups!

Why would a hospital system stand for many exclusions? Where does all the money go? I can’t tell you where the money actually goes – that is the secret sauce of PBM spread pricing, reimbursement, rebates and total lack of transparency that these drug middlemen thrive off. Great article here about Express Scripts exposure on drug pricing during their very public break up with Anthem, the largest for-profit managed health care company in the Blue Cross Blue Shields Association. That topic is for another day.

Here’s the sage advice of the day: co-develop, co-develop, co-develop! It is the only way to get fit fast, be in shape to wrestle with the PBMs, avoid the contract pharmacies and drive greater care and revenue back to the health system. Shields Health Solutions, as you know is my proud home, is THE ONLY Specialty Pharmacy and Care Integrator in the world that focuses on bringing the Specialty Pharmacy in-house, owned by the hospital.  I usually tackle topics without the plug but this one is a must. http://www.shieldshealthsolutions.com or contact me below and I will make sure that Shields helps you get in shape to tackle the PBMs.

As always, keep the feedback coming at contact@thespecialtysage.com.

 

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