Insights and updates from Gates Healthcare Associates
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OUT OF THE GATES
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We've only just put down our forks from Thanksgiving, but that doesn't mean it's too early to start planning for the new year.

Here at Gates Healthcare Associates, we already have a fresh offering in mind for 2017 as we continue to enhance our array of consulting services: Compounding SOPs developed by our Senior Associate Joe Cabaleiro, RPh, who is an unparalleled expert on the subject.

SOPs assure the quality and safety of drug preparations. They are your recipe for ensuring that all the important steps of a particular process are performed. Just say SOP in full -- Standard Operating Procedure -- and you immediately sense its authority.

Compounding is complicated. But well-written SOPs incorporate standards of practice, regulatory requirements, equipment settings and other vital parameters, so that nothing is overlooked. They serve as a set of instructions to ensure that a particular task is accomplished and properly documented.

Without a doubt, SOPs save pharmacies time and money.

Please feel free to get in touch with Joe Cabaleiro or me if you'd like to learn more about the compounding SOPs we are developing for our clients' use and benefit in 2017 and beyond.

Best wishes.

Sincerely,
Ernest P. Gates Jr., RPh, FASCP, FIACP, FACA
President, Gates Healthcare Associates

       
Upon Further Review: Pharmacies Can Benefit From Thorough Assessment of PBM Contracts

There is more to a PBM than meets the eye.

While Pharmacy Benefit Managers come under increased scrutiny for their pricing practices and relationships with drugmakers, it's important to take a closer look at PBM contracts with pharmacies and how these agreements affect audit outcomes and can create reimbursement challenges.

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The vast majority of third-party claims today are processed through large PBMs, and most pharmacies must participate in a PBM's network in order to gain access to those prescriptions filled on behalf of health plans and employers who contract with a PBM. The terms and conditions for participating in a network are driven by the PBMs, but their adherence to these agreements is seldom assessed for compliance by pharmacies.
 
A PBM Contract Assessment by Gates Healthcare Associates can provide a pharmacy with an opportunity to comprehensively review processed Rx claims to identify opportunities for improvement by the PBM or by the participating pharmacy, or by both parties. An assessment typically covers a review a year's worth of Rx claims and includes the following:
  • Brand reimbursement
  • Generic reimbursement
  • Dispensing fees
  • Specialty drug reimbursement
  • MAC pricing vs. acquisition cost (sample of top 10 MAC drugs)
At the end of a PBM Contract Assessment, a pharmacy receives a comprehensive document outlining observations and suggestions for improvement. This includes specific claims where it appears that reimbursement is less than expected based on a review of the network agreements with the PBMs, as applicable.

For more information about PBM Compliance Services, please contact Gates Healthcare Associate Paul O'Connor, RPh, MBA at paul.oconnor@gatesconsult.com. 
 
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