Payor Access: Nuances of the Payor Landscape

Access to payor networks is a key component of specialty pharmacy success. It increases the prescriptions available for patients and creates new revenue opportunities for hospitals and health systems. Unfortunately, obtaining and maintaining access can be a complex challenge, especially in the specialty pharmacy space.

CPS is hosting a Payor Educational Webinar series this summer (Summer 2022)

In our first session, John Luebker, CPS' Vice President of Specialty Pharmacy of Payor Strategies, provided an overview of the payor landscape, summarizing the essential information specialty pharmacies must know about the industry to begin building and growing relationships with specialty payor networks.

Topics discussed included:

• Communication barriers that arise between pharmacies and payors, due to the separation of medical and pharmacy benefits
• How the increase in vertical integration has created payor silos that restrict outside networks from obtaining access
• The importance of detailed clinical reporting required by payors to demonstrate positive outcomes for high-cost medications
• Comprehensive technology solutions that are necessary to keep up with payor demands for data and to attain and retain accreditation

The nuances of the specialty payor market are complicated and must be navigated using a proven, strategic roadmap. CPS has years of experience supporting hospitals and health systems with all of their needs across the specialty pharmacy ecosystem, including payor access.

To learn more about the payor market, specialty vs. retail access requirements, obstacles to access, and tactics to overcome them, contact us today to schedule a meeting with one of our experts.