Legal Considerations and Challenges for Hospital and Health-System Specialty Pharmacies
Current pharmacy benefits landscape in the context of the drug supply channel, and in particular, the role that health system pharmacies play will be discussed. This session will focus primarily on payor and PBM concerns for health system pharmacies (including heightened barriers of entry, disproportionate copay tiers versus PBM-owned pharmacies, and unreasonably low reimbursement rates). The presentation will include real world, practical advice to pharmacists and administrators on how to navigate these difficult payor challenges and look for opportunities for growth. The presentation will also cover other laws and legal principles, including Board of Pharmacy considerations, 340B regulations, antikickback and self-referral laws, and more.
Target Audience
- Pharmacists
- Pharmacy technicians
Learning Objectives
Pharmacist learning objectives
- Discuss current pharmacy benefits landscape in the context of the drug supply channel, and the role that health system pharmacies play
- Identify payor network admission criteria for various PBM networks requirements, and learn to navigate nontransparent, unclear, continuously changing, and onerous requirements
- Address the framework of laws and regulations that impact health system pharmacies, including rules regarding network access, benefits design, fair audits, and reimbursement rates
Pharmacy technician learning objectives
- Define the NCPDP fields relevant to 340B claims billing
Additional Information
Attachment | Size |
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Helpful Tips for Users.pdf | 157.72 KB |
Instructions for Obtaining CE Credit - Legal Considerations and Challenges.docx | 29.99 KB |
Available Credit
- 1.00 ACPE Pharmacist
- 1.00 ACPE Pharmacy Technician
- 1.00 General CE - Attendance