3. Find creative ways to navigate reimbursement challenges
Melody acknowledges that in today’s environment, reimbursement challenges can make starting a specialty pharmacy business a particular challenge. She says that many insurance plans require patients to get their specialty pharmacy prescriptions filled through a PBM – and Medicare DIR (direct and indirect remuneration) fees made it very challenging to cost effectively fill specialty scripts for Medicare patients.
These reimbursement challenges can certainly be deflating – to a business owner’s drive and to a pharmacy’s bottom line. Overcoming challenges like these takes grit, determination and a good amount of networking and creativity.
For example, Melody got to work, researching the Federal 340B Drug Pricing Program -- which allows healthcare organizations that serve a disproportionate number of uninsured and low-income patients to access outpatient medications at discounted prices. When she realized that 340B prescriptions aren’t impacted by Medicare DIR fees, she started actively pursuing opportunities to fill specialty prescriptions for patients served by local healthcare providers who participate in the 340B program.
Melody’s diligence in finding a way to grow her specialty business has also paid off in other ways. Filling 340B prescriptions provides Melody and her team the chance to make a meaningful difference in the lives of low-income patients who are dealing with chronic and often life-threatening diseases – patients who can really benefit from a personal, face-to-face relationship with a community pharmacist they trust.