The Importance of Payor Credentialing When Selecting a Specialty Pharmacy Partner
Whether it's open, limited, or exclusive, the main goal of all healthcare distribution network systems should be to provide patients access to the needed medications in the most efficient and affordable way possible. One of the initial steps in the RFP process is payor credentialing to see which specialty pharmacy can meet this goal. Many pharmacy benefit managers (PBMs) have some type of comprehensive credentialing process in place because rare diseases are complex with many drug nuances to manage.
Accreditation can be a critical component of differentiation for both payors and drug manufacturers when considering partnering with a specialty pharmacy.1 Through accreditations, especially in rare diseases, payors and pharmaceutical manufacturers are given the confidence that their health plan members and consumers are provided with the expertise needed to handle these specialty medications and specific patient care needs appropriately. Many specialty pharmacies, including Orsini, have URAC or ACHC accreditations, which is foundational to have a third party review of policies, procedures, and processes.
Partnering with the right rare disease specialty pharmacy becomes critical to the overall management of the patient ecosystem. “From a payor perspective, we might see one or two ultra-rare disease patients in a year. So, it’s really about (the specialty pharmacy) being available when that type of care is needed to do the “rounds” from the moment of diagnosis to prescription fulfillment and making this process as simple as possible for that patient as each situation is sensitive and unique.” - Chandra Wahrgren, MBA, SVP, Corporate Pharmacy Enterprise & Innovation, Moda Partners.
When considering a rare disease specialty pharmacy, it is imperative to find one that can deconstruct the complexities of rare and ultra-rare disease situations and effectively manage the nuances of the rare disease drugs so that the process becomes completely “seamless” to the patient experience. Learn more about how Orsini Specialty Pharmacy partners with payors,patientsand biopharma.
Click here to download our whitepaper detailing what payors should consider when evaluating a specialty pharmacy partner.
1. Menkhaus T, Winkle JL, Crocker A, et al. Pursuing specialty pharmacy accreditation. Pharmacy Times. https://www.pharmacytimes.com/view/pursuingspecialty-pharmacy-accreditation. Published January 25, 2019. Accessed August 16, 2022.
Orsini is a leading independent national specialty pharmacy accredited by ACHC, JCAHO, URAC, and VIPPS. The services we provide allow patients, physicians, payers, and manufacturers to improve care, simplify processes, and achieve better outcomes.