Elevate Provider Network
A Balanced Approach to Preferred Networks
Pays off Big for APRx's Elevate Members
Our competitors like to boast to independent pharmacy owners that their PSAOs participate in a lot more preferred networks than does our Elevate Provider Network, the PSAO of AmerisourceBergen. More is automatically better, it would seem.
AmerisourceBergen instead models and evaluates payer contracts with a balanced strategy that differentiates member access from provider preference, considers both access and margin, and is better for your pharmacy. That’s why Elevate member pharmacies realize an average of $6-$7 more per Aetna/Coventry/First Health generic prescription than its two largest competitors’ pharmacies. And fewer generic claims were paid at a loss for Elevate members accepting standard rates than for members of PSAOs electing Aetna’s preferred rates.
New CMS policies added transparency to the reimbursement concessions that pharmacies must accept to join Aetna’s preferred network. Confronted with the magnitude of those concessions, some PSAOs are rushing to provide limited “bailouts” to reimburse their customers, and are requesting emergency meetings with Aetna to manage the impact of unsustainable reimbursements.
Elevate’s Calculated Approach
The Elevate Provider Network carefully considers the assumptions of preferred networks, taking a deeper look at the math behind those assumptions. That methodology produces an inescapable conclusion: Participating in preferred networks with reimbursement rates that are too aggressive results in profit losses that are unsustainable for independent pharmacies. Copay incentives motivate only a limited number of patients to move to preferred pharmacies, and will not offset the impact of generics dispensed at a loss.
Elevate takes the balanced approach, maintaining access to patients while negotiating a better Generic Effective Rate (GER) than what is initially offered. It carefully and selectively considers the plans at the preferred or standard level based on the terms of participation and patient incentives—ensuring APRx members remain profitable. Elevate reviews claims and submits reimbursement challenges as appropriate to ensure members get the maximum payment possible. In Aetna’s case, participating in the standard network means access to the same number of lives as in the preferred network, but at more sustainable rates.
Sustainable reimbursement rates are necessary for pharmacies to take care of patients and operate profitably. That is Elevate’s balanced approach in action—the right balance of competitiveness, profitability and access to patient lives.