Sovaldi & Pharmacies

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Anonymous

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Do the specialty pharmacies have different contracts with insurances when it comes to reimbursement for them? Can pretty much any specialty pharmacy order Sovaldi? Whats the difference between using one specialty pharmacy vs another?
 


















Anonymous said:
And Gilead obviously is buying relationships with SPs based on the feedback customers are mentioning how certain SPs are going above and beyond to get Sovaldi or harvoni approved. Don't worry, I don't work in HCV, so I don't have any skin in this game
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Get off the board you can't stand that we are better than you, data speaks for itself.
 






Anonymous said:
You obviously don't work here so get lost
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I'll be transparent, I do not work here but looking to get into the specialty pharmacy business because it is very lucrative. I could potentially double what I make as a rep. I can share insight on the specialty pharmacy business side in exchange for a little more information. For example, the specialty pharmacies are now giving reps who promote these high profile drugs an extra 50-60k base plus commissions if they can convince the doctors to send their scrips to the specialty pharmacy to get filled. I'm just not 100% on insurances with these pharmacies, like is it different with each pharmacy even it is within the same state? How do you guys connect thee specialty pharmacies with your physicians? What are the challenges you guys see when the script goes to the pharmacy? Does the new electronic prior authorization make an impact? I will star this thread because I sincerely want some insight. Thank you
 


















Most speciality pharmacies can fill between 6-7 out of 10 scripts. This is because many insurance plans have exclusive agreements with specialty pharmacies to get the best deals. Caremark and Accredo have the most contracts. Aetna is sending most of their scripts to their own pharmacy unless it's Medicare Part D. Exclusive agreements are becoming more the norm so the SP's are scrambling to get in on these deals. The big guys as usual have the most chance of elbowing in but they do the least to help the patients get approval. It's all about money and the insurance companies are doing all they can to save money right now.
 






May I ask what is the difference between "Specialty Pharmacy" and PBM.

I understand what is a Pharmacy Benefit Manager (PBM) like Express Script or CVS/Caremark, :

PBMs are doing the following:

- A third party administrator (TPA) of prescription drug programs.

- Or a service inside of an integrated healthcare system (e.g.: Kaiser or VA).

-They are primarily responsible for processing and paying prescription drug claims.

-They also are responsible for developing and maintaining the formulary

- Negotiating discounts and rebates with drug manufacturers.

It's the middle man between the Insurer and the drug manufacturers.

Is there an other middle man with the "Specialty Pharmacy"? if yes that will make a collection of middle men, and I really cannot appreciate the need for it. No wonder drug prices are so high in the US.

Thanks in advance for the clarification.
 






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