Long-term care (LTC) operators have long understood the impact of rising pharmacy costs on their bottom lines.
These costs often represent the second-largest cost center for most operators. What most LTC operators may not fully understand is the complexity and lack of transparency in their pharmacy relationships and how that could mean the difference between being in the black or red.
Finding a good pharmacy partner and securing a transparent, fair, and equitable contract can be one of the most important factors for operators in taking control of pharmacy spend. Claims data and inputs are extremely complex, creating an environment ripe for errors and making it difficult to have any actionable insight into what is going on. The only way to solve for this complexity, reduce inaccuracies, and introduce transparency is to integrate automation and technology into pharmacy relationships.
As with any vendor, the level of service and technology integration varies widely from vendor to vendor. Some pharmacies have already integrated automation into their processes, offering services like adjudication and real-time data transfer, while others continue to rely on outdated or manual processes that make it difficult and inefficient to get data to operators in a timely or comprehensive manner.
This series of articles will discuss the benefit of building greater transparency into pharmacy relationships and how this can add value for operators in terms of the following key areas: time, money, and compliance.
When errors occur in pharmacy management, one of the biggest issues is the amount of time it can take to identify the errors and submit requests to the pharmacy to resolve errors and receive credits for pricing discrepancies. The longer it takes to request credits, the less likely the credits are to be recouped. Pharmacies that are willing to adjudicate claims in real-time are able to best serve clients in preventing errors from ever occurring. Adjudication builds parameters based on contract terms and formulary specifications into an automated system that alerts operators when there is an issue with claims. This can significantly reduce the amount of time spent chasing returns and credits.
The sheer number of claims submitted by a long-term care facility, combined with fluctuations in pricing databases and fuzzy contract terms leave a lot of room for errors on bills. From pricing discrepancies to eligible manufacturer rebates, these dollars can add up to millions of dollars depending on the size of an operator. Without technology and automation building transparency into their pharmacy relationships, operators risk leaving these valuable dollars on the table.
In an industry as closely regulated as long-term care, staying compliant requires a high level of insight into operations and processes. Pharmacy management practices are also subject to regulation and require regular review of rebate submission areas to remain compliant. As the payer on drug claims, operators are eligible for rebates that are subject to regulations. Accurate data and reporting are critical and are most efficient when technology is automating those processes.
Building a higher level of transparency into pharmacy management practices not only increases peace of mind, it improves measurable outcomes related to costs, waste management, and efficiencies. With so much riding on proper management and control of this cost center, operators need to work with pharmacy partners to implement technology and processes that allow more efficient reporting, real-time insight, actionable analysis, and adjudication in order to prevent errors from occuring in the first place.
In this four-part series, we will explore each of these areas in more detail, and discuss how to achieve greater transparency into LTC pharmacy relationships. If you would like to receive the articles in this series, please enter your email address below:
SRX is a technology and advisory company that helps LTC operators realize the lowest net cost on pharmacy spend. We help our customers improve drug utilization, manage pharmacy relationships, reduce costs and waste, and maximize rebates. SRX technology also analyzes pharmacy contracts, identifies areas of concern, and makes recommendations regarding cost savings opportunities through automation, adjudication, and drug utilization. We are committed to transparency and accountability and guarantee quarterly rebates that are paid on time, every time. Contact us at 833 633 6833.
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