PersonalMed™ Frequently Asked Questions
Further, the other PPN’s that also are currently in formation have announced their intentions to create extremely small networks. We believe that a larger PPN will have much greater negotiating power with third-party payors and PBMs to be able to provide the nationwide reach that they want for their prescribers and patients. PersonalMed is being structured in such a way that it will deliver the quality assurances and wide availability that payors and PBMs demand.
What is PersonalMed?
PersonalMed is a preferred provider network (PPN) of compounding pharmacies that are members of PCCA and meet strict standards of credentialing and quality assurance. Its purpose is to assure that their patients continue to have access to and receive reimbursement for the custom-compounded preparations on which their health depends, at costs their employers can predict and afford.What will PersonalMed negotiate on behalf of its members?
Ultimately, the answer depends on the group’s relationship with individual payors and PBMs. However, these terms will include, at minimum, formularies, reimbursement rates, auditing and inspection requirements, clean room certification (sterile compounding only) and quality and safety standards.How large is membership in PersonalMed?
Our goal is to make PersonalMed the largest compounding PPN in the industry with the broadest geographic coverage possible. PersonalMed is in formation now. Already 000 PCCA members have expressed interest in joining the network.How does PersonalMed differ from other PPN’s that are being formed now?
PersonalMed will offer a complete billing service, fully integrated with the most widely used compounding software in the United States. None of the existing or announced PPNs have plans to include a billing solution among their services. None of them can integrate with the most widely used compounding software, PK , which is wholly owned by PCCA. In addition to its obvious benefits, the billing service will allow PersonalMed to leverage collected data to do critical reporting and to conduct outcome studies.Further, the other PPN’s that also are currently in formation have announced their intentions to create extremely small networks. We believe that a larger PPN will have much greater negotiating power with third-party payors and PBMs to be able to provide the nationwide reach that they want for their prescribers and patients. PersonalMed is being structured in such a way that it will deliver the quality assurances and wide availability that payors and PBMs demand.
How will PCCA-Member pharmacies qualify for membership in PersonalMed?
In addition to having an active PCCA membership, applicants to PersonalMed must have achieved PCAB Accreditation or commit to starting the accreditation process within one year of joining PersonalMed. The great majority of PCCA-member pharmacies have the capacity to become qualified. Any PCCA-member pharmacy that is willing to accept the negotiated pricing terms, all credentialing requirements and other terms and conditions set by PersonalMed may participate.Will PersonalMed be an intermediary between member pharmacies and payors in conflict resolution?
Yes.Let’s Talk.
To start a conversation about doing business with the PersonalMed PPN, call Delford Doherty, director of Managed Care Services, at 800.331.2498 x 1011 or email PersonalMed@PCCARx.com .
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