Payor Access: Obtaining Access to Specialty Networks

If your hospital or health system is investing in specialty pharmacy services, access to key payor networks will be critical to success. It empowers your organization to serve a broader patient population and strengthen its financial performance. But payors have high standards for access. At the end of the day, they all want to know: why should I let you in my network?

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

In our second Payor Access Webinar session, CPS' VP of Payor Strategies, John Luebker, addressed this topic head-on: your responsibility is to demonstrate the value you provide to payors. If you can do that successfully, your organization wins.  

This webinar covered three key areas to review as you seek to demonstrate your value and gain payor network access.

1. Data. As a lynchpin between providers and patients, your specialty pharmacy is in a unique position to capture incredible data that payors want to see, particularly as they move towards outcomes-based approaches. From prescription volume and dispensing information to prescriber lists and referral rates, your specialty pharmacy needs to capture the vital information that illustrates its performance in the continuum of care.
2. Selling Strategy. Data alone won’t get you an invitation to the party, but it will play an important role in shaping your selling strategy. This is where your specialty pharmacy should package up data into a digestible narrative, making it easy for payor networks to appreciate the value you offer their members.
3. Accreditation and Credentialing. Both are important milestones required for access, but they are not one and the same. While accreditation may be a minimum requirement, credentialing is the payor-driven standard that will get you through the door. Specialty pharmacies must learn the difference and how to meet both requirements.

The specialty payor market is complicated. This summary just begins to scratch the surface of information that specialty pharmacies will need to successfully obtain access. In the full webinar, John Luebker goes into greater detail about each of these steps and how your organization can begin to accomplish them.

CPS is a partner that can help you with successfully obtaining access to the payor networks that make sense for your pharmacy. Contact us today to schedule a meeting with one of our experts.