Complete the form below to access the webinar replay.
The recently announced merger of two large PSAOs, AlignRx and Pharmacy First, has created many questions and uncertainty among pharmacy owners.
Dr. Lisa Faast invited PSAO data wizard Kyle Shinn from ICBN to explore the merger's meaning and how selecting the correct contracting method for your specific pharmacy can increase your pharmacy's profits.
There is no ONE best PSAO for every pharmacy. It will greatly depend on the patients you have, their insurance, and what they are prescribed. This is a highly insightful webinar with one of the smartest experts on pharmacy contracting.
Pharmacy owners who want more freedom, increased profits, and LOVE owning their pharmacy are invited to join Pharmacy Badass University.
Outline
Impact of Pharmacy First and Align RX Merger
- Lisa Faast introduces the webinar, focusing on the impact of the merger between Align RX and Pharmacy First on pharmacy owners.
- Lisa emphasizes the importance of choosing the right PSAO and the significant impact it has on pharmacy profitability.
- She introduces Kyle Shinn from ICBM, highlighting his expertise in healthcare contracts and data analysis.
- Lisa explains the complexity of choosing the best PSAO, noting that the best option varies based on patient mix and location.
Choosing the Right PSAO
- Lisa discusses the benefits of direct contracting versus using a PSAO, emphasizing control and transparency.
- She mentions her own journey from being fully direct contracting to understanding the value of PSAOs.
- Lisa highlights the importance of understanding the patient mix and the contracts offered by different PSAOs.
- She encourages pharmacy owners to educate themselves on contracting options and to consider the impact on their gross margin and profitability.
Introduction of Kyle Shinn and ICBM
- Lisa introduces Kyle Shinn, detailing his extensive experience in healthcare and pharmacy management.
- She praises ICBM for its support and growth strategies for independent pharmacy owners.
- Lisa recommends ICBM for its Medicare agent program and PSAO analysis services.
- She transitions the discussion to Kyle, who will speak about the merger between Align RX and Pharmacy First.
Overview of Align RX
- Kyle provides an overview of Align RX, noting its recent merger with two PSAOs and its current status as the largest independent wholesaler-agnostic PSAO.
- He explains Align RX's contracting strategy, including its use of effective rate contracts and straight MAC language for generics.
- Kyle discusses the benefits and risks of MAC reimbursements, emphasizing the lack of protections for aggressive MAC rates.
- He highlights the importance of understanding the PBM contracts and the impact on reimbursement rates.
Pros and Cons of Align RX
- Kyle outlines the pros of Align RX, such as no effective rate clawbacks and its wholesaler-agnostic status.
- He discusses the cons, including the lack of generic protection for aggressive MAC rates and the absence of Express Scripts and Prime Therapeutics contracts.
- Kyle provides insights into the merger process and the potential impact on pharmacy first customers.
- He emphasizes the importance of understanding the specific needs and patient mix of each pharmacy when choosing a PSAO.
Pharmacy First Overview
- Kyle provides an overview of Pharmacy First, noting its regional presence and its use of effective rate contracts with Caremark and Optum.
- He explains Pharmacy First's store-level true-ups for effective rates and its value-add services like claim reconciliation.
- Kyle discusses the impact of the merger on Pharmacy First customers, including the transition to Align RX contracts and the potential loss of effective rate protections.
- He highlights the importance of understanding the specific contracts and true-up methodologies of different PSAOs.
Considerations for Prospective Customers
- Kyle discusses the considerations for prospective customers, including the impact of effective rate contracts and the importance of understanding the true-up methodologies.
- He provides insights into the differences between wholesaler-owned and independent PSAOs, emphasizing the potential conflicts of interest.
- Kyle highlights the importance of analyzing the product and payer mix to determine the best-fit PSAO.
- He encourages pharmacy owners to seek professional help in understanding and navigating the complexities of PSAO contracts.
ICBM's Support and Services
- Kyle explains how ICBM can help pharmacy owners leverage the information about the Align RX and Pharmacy First merger.
- He describes the deep dive claim analysis service, which helps pharmacies understand their product and payer mix and determine the best-fit PSAO.
- Kyle highlights the benefits of ICBM's brokerage program, including the ability to enroll patients in Medicare plans and earn commissions.
- He emphasizes the importance of understanding the synergies between the brokerage and pharmacy operations to maximize revenue and profitability.
Q&A Session
- Lisa and Kyle address questions from the audience, providing additional insights and clarifications on various topics.
- They discuss the impact of DIR fees on reimbursements and the importance of understanding the true-up methodologies.
- Kyle provides tips on how to manage Medicaid claims and avoid clawbacks of higher dispensing fees.
- They emphasize the importance of staying informed and proactive in managing pharmacy contracts and reimbursements.
Watch the full replay here for all the details and tons of Q&A with Kyle Shinn & Dr. Lisa Faast.
Contact Info: Kyle Shinn, ks****@****bn.com, or book a call HERE.
Pharmacy owners who want more freedom, increased profits, and LOVE owning their pharmacy are invited to join Pharmacy Badass University.