Medically integrated dispensing: What specialty practices need to know before they build a program

Specialty practices are increasingly asking the same question: should we bring dispensing in-house? The Cencora team recently hosted a webinar that tackled that question head-on, providing an overview of the operational and business realities of building a medically integrated dispensing (MID) program.

Here’s what practice leaders need to know.

What is medically integrated dispensing?

MID is a dispensing entity embedded directly within a medical facility, with access to the patient’s EMR and full integration into the care team. Rather than sending a prescription out the door and hoping for the best, the practice becomes part of the fulfillment process, creating a more connected, coordinated experience for the patient.

MID started in oncology, but the model has since expanded into urology, rheumatology, gastroenterology, allergy/immunology and ambulatory infusion centers. Cencora’s team brings hands-on experience across each of these specialties.

That connection translates into real clinical and operational advantages:

• A true one-stop shop: Patients see their provider and pick up their prescription in the same visit, without an extra trip to the pharmacy.

• A 360-degree view of the patient: With access to medical therapies, labs, allergies and socio-economic indicators, care teams can make more informed decisions and act as stronger advocates for their patients.

• Better adherence and faster starts: Data consistently shows that patients filling prescriptions through an MID adhere to therapy more closely and begin treatment faster – and side effect management is easier when the care team and pharmacy are one and the same.

• Less waste: Closer monitoring means practices aren’t dispensing a 90-day supply only to have a patient switch therapy midway through, wasting medication and money.

One Cencora approach

A successful MID program depends on a coordinated network of support. That is philosophy behind Cencora’s “One Cencora” approach: multiple divisions working in concert, typically coordinated through a dedicated pharmacy services team so practices have a single point of contact for everything they need.

Cencora’s network includes:

• Specialty GPO Networks (ION and SPN): Maximizes purchasing power across membership and optimizes contract performance.

• Specialty Distribution (Oncology Supply and Besse Medical): Sustains an efficient, high-standard specialty supply chain nationwide.

• Specialty Solutions: Provides financial and operational support spanning pharmacy services, accreditation, analytics and payer solutions.

• Two pharmacy services administrative organizations (PSAOs): Improves payer access and contract terms via Elevate Provider Network and Accelerate Specialty Network.

Today, Cencora supports more than 250 dispensing sites and 2,900+ physicians nationwide, with a team that brings both deep specialty knowledge and a community that practices can lean on for best practices and industry insights.

Navigating the regulatory maze

One of the biggest hurdles practices face is navigating the rules governing MID. MID rules vary significantly by state. Some states require the entity to be a licensed pharmacy under the board of pharmacy, which means a pharmacist must be on staff. Others allow an MID site to operate under the physician’s license, sometimes without a pharmacist at all. And in some states, a physician-owned entity can’t operate an MID under any structure.

The good news is practices don’t have to figure it out on their own. Cencora’s teams support and guide practices as they navigate the various regulations and help filter through what applies to their state and specialty.

Why a PSAO matters – and why two is better than one

Having a PSAO in a practice’s corner is very important as they deliver high-quality patient care through increased access to payer networks and better contract terms. On the pharmacy side, payer contracting is largely take-it-or-leave-it – there’s little room to negotiate the way there is on the medical side. If you want to be in a specific network, you must agree to its terms. PSAOs can negotiate better terms with payers on behalf of all the pharmacies that are part of their network, including MID sites. Cencora is the first distributor to offer two PSAOs: Elevate Provider Network and Accelerate Specialty Network.

Elevate Provider Network is a market-leading retail PSAO that all Cencora MID customers automatically join. Elevate has 50+ pharmacy benefit managers (PBMs) under contract and several thousand individual plans in its network. More than 5,000 pharmacies nationwide – including MID programs – are part of Elevate, giving the network real leverage when negotiating with payers. In addition to negotiating rates, they also negotiate audit look-back periods, recoupment terms and more. Joining Elevate means a practice is automatically part of these negotiated terms, with no separate contracting or credentialing required. Additionally, Elevate’s Central Pay feature simplifies reconciliation, consolidating what might be dozens of individual payer reimbursement checks into a single deposit.

Accelerate Specialty Network launched in 2021 as the industry’s first specialty-focused PSAO. Accelerate negotiates contracts for specialty medications that are often mandated to mail order pharmacy or a limited pharmacy network. When a practice joins the Accelerate network, they are able to capture those medications in-house 98% of the time, turning what would otherwise be lost volume into retained revenue. Accreditation is required, which is why newer MID sites typically aren’t steered toward Accelerate right away. Instead, practices go live with their MID site first, and Cencora works with them to determine whether and how much opportunity exists to bring those claims back in-house.

Pharmacy services and solutions that support the full lifecycle

Cencora supports MID programs with a white-glove approach, handling as much of the heavy lifting as possible so practices carry less of the administrative burden. Ongoing support and solutions fall into three categories:

1. SmartRx Fill and MID start-up: Includes practice discovery, pro forma development, payer contracting strategy, enrollment and workflow guidance for both new programs and newly onboarded existing ones.

2. SmartRx Fill and MID optimization: Includes ongoing support once a program is live, including claims troubleshooting, reimbursement review, audit services and quarterly dispensing reviews. Audit support is particularly valuable for physician sites without a pharmacist on staff, since audits are a routine – and potentially costly – part of pharmacy operations.

3. Accreditation support: Includes certified ACHC and NCODA consultants who help practices choose the right accrediting body and build out the standards, procedures and project plans required to get there.

Support may also include access to BestRx pharmacy software through Cencora’s SmartID program for practices seeking a pharmacy management solution, although use of the software is not required.

Unique opportunities for Cencora MID sites

Prime IntegratedRx® is a first-of-its-kind PBM offering, launched in partnership with Prime Therapeutics. This offering is designed to keep complex specialty patients connected to their local providers rather than routed to a traditional PBM-affiliated specialty pharmacy. Because Prime Therapeutics is a part owner of Blue Cross Blue Shield in multiple states, participating MID sites can capture specialty claims that would otherwise be mandated out. Currently, therapies are concentrated in oncology, urology and cystic fibrosis, but they are continuing to expand to other therapies. Accreditation is required, though practices can join the network first and have a full year to complete it.

Beyond claims capture, the program is designed to drive new market share for MID, support value-based care models that help practices stay competitive with payers and increase access to specialty drugs and supportive care products that would otherwise go to a specialty pharmacy. It has also been shown to improve patient and provider experience and lower overall cost trends compared to the traditional PBM specialty pharmacy model.

SmartRx Analyzer is a data analytics platform built to give practices a clear view of true profitability – factoring in GPO rebates to show net cost, not just gross margin, and allowing practices to filter by therapy category or drug type. As an intuitive business intelligence platform that pulls from multiple data source formats, it’s built to be flexible enough for practices to explore the data however they need. For many practices, it provides transparency into the financial picture behind their dispensing program.

Making MID work for your practice

MID makes it easier for patients to fill prescriptions and allows practices to capture revenue from specialty medications and supportive care products that would otherwise be lost to retail or specialty pharmacies. With coordinated support across GPO, distribution, PSAOs and pharmacy services teams, specialty practices have a clear path to launching and optimizing an MID program that improves care and strengthens operations.

Watch the full webinar to learn more about how an MID can benefit your practice and how Cencora can help: [link here]