Strengthening Pharmacy Reimbursement

Health system reimbursement for provider-administered medications is at risk. Many health systems are already writing off substantial medication-related revenue because of ineffective management of medication prior authorizations and denials.

Two current trends further elevate the potential for significant financial losses on provider-administered medications. First, payers are increasing restrictions on which patients and drugs can be infused in hospital-based infusion settings. Second, rising drug prices and a growing pipeline of high-cost specialty medications mean the impact of each medication denial is increasingly expensive.

To mitigate both present and imminent financial challenges from medication-related denials, health system finance and pharmacy leaders must partner together to strengthen pharmacy revenue cycle processes.