FACT: You may never know where your hospice dollars are truly going without REAL transparent Rx billing.
In its simplest form, REAL transparency promotes full and open disclosure of all sources of the pharmacy benefit manager's (PBM) revenue, at all levels to the hospice, when it comes to managing the billing of hospice covered medications in end of life care. Real transparency allows trust to develop amongst all stakeholders (hospice, dispensing pharmacy, pharmacy benefit manager), working together to provide an ultimate end product or service. Real transparency allows the entire industry to work better; and real transparency is ethical.
As one of the nation’s leading hospice pharmacy benefit managers (PBM), Delta Care Rx has been a stand-alone promoter in the industry of “real transparency” via an innovative Rx billing model known as Hospice Taper®.
The two words “real transparency” are placed in quotations for very good reason. The smoke and mirrors mentality of what has quickly become a wall-street-owned and operated hospice PBM industry has done its best to make it appear that steps are being taken to adopt proper transparent billing models. However, the truth is that traditional models are simply being repackaged, remarketed, and then resold. This practice suggests that the new billing models are the PBM’s “transparent solution.” In actuality, they are still very far from what is defined as “real transparency.”
Without real transparency, a hospice cannot be sure that the PBM is negotiating the lowest possible costs for drugs on their behalf.
Without real transparency and visibility of volume driven rebates, a hospice cannot be sure that formularies, often times presented as being “preferred” by the PBM, are really in the best interest of the hospice and its’ patients. When non-transparent PBM‘s are motivated by possible profits from hidden revenue streams (like rebates), there is always a chance that the integrity of the non-transparent PBM’s clinical decision team may be compromised.
Without real transparency of what the PBM pays for medications (a.k.a. pharmacy reimbursement), versus what it then charges the hospice, a hospice cannot count on maintaining long-standing relationships with local pharmacy providers. Why? In many cases, pharmacies are being inadequately reimbursed by the PBM for the filling of hospice medications. The spread or difference between what the PBM pays the pharmacy as reimbursement versus what is charged to the hospice, can often be a large sum of money (profit to the PBM).
Without real transparency, the hospice cannot be sure they’re honestly receiving the drug pricing outlined in their contract with a PBM. It should be a red flag if a PBM uses phrases such as “Internal AWP” "Manager's MAC" or “Internal MAC List.”
Delta Care Rx always offers complete transparency at all levels when it comes to forming a billing model that fits YOUR hospice organization specifically. Does your current hospice pharmacy solution provider or PBM offer REAL TRANSPARENCY?