January 24, 2024
Hospitals today operate in a very challenging financial environment. And as the cost of drugs continues to climb, the hospital pharmacy has come under the microscope for scrutiny.
The pandemic drove up costs across the board, including COVID-19 treatments like remdesivir, a specialty drug that topped hospital drug spending for the third straight year in 2022, according to the American Society of Health-System Pharmacists.
Spending on specialty drugs continues to drive up overall costs for medications, rising 43% since 2016 to reach $301 billion in overall pharmaceutical expenses in 2021, according to federal data. The increase is attributed to new specialty medications for the treatment of rare diseases, cancer, diabetes, autoimmune disorders, and Alzheimer’s disease.
Meanwhile, pharmacy leaders continually evaluate medication expenses against clinical efficacy, payor coverage and the hospital formulary, while also considering WAC purchasing, 340B opportunity and the growing availability of lower-cost generics and biosimilars.
Success in pharmacy requires:
- Strong 340B performance and compliance
- An accurate formulary to drive billing and accumulations
- Payment and margin intelligence
- Real-world benchmarking
- A defensible pricing strategy
- Improved revenue cycle management with fewer denied claims and faster reimbursement
Rather than viewing the pharmacy as a cost center and a place to carefully manage expenses, hospitals should think of it as a primary contributor of revenue to the organization — a department worthy of being managed as a business.
Yet making this shift means overcoming inertia and many challenges. Pharmacy data is siloed and does not inform workflows, and pharmacy leaders typically have limited visibility into the reimbursement they’re receiving for the drugs they dispense.
What’s more, there are many sources of revenue leakage, including coding inaccuracies, newly purchased drugs missing from the chargemaster, capturing charges correctly, problems reconciling volumes, applying incorrect multipliers, and inappropriate charging on self-administered drugs.
Pharmacy leaders need technology, expertise and resources to manage the complex medication cycle from procurement through dispensing, charging, claims management, and reimbursement.
It’s why we’ve developed the Trisus® Business of Pharmacy Suite of applications.
Trisus® Business of Pharmacy is one of our new product suites, combining complementary applications to enable pharmacy leaders to take a more active role in procurement, charging, billing, and reimbursement. It consists of the following solutions:
- Trisus Medication Formulary, which ensures all drug purchases are captured in the formulary and correctly coded and charged, despite changing purchasing patterns due to drug shortages or other issues
- Trisus Medication Financial Management, which assesses purchase, billing, and remittance data to provide visibility into margins at the individual medication level, empowering more informed decision-making
- Trisus Medication Claim, an application that accelerates payment for pharmacy claims, minimize denials and manages complex, government-mandated reporting requirements
- Trisus Medication Compare, a longitudinal database that allows users to compare treatments, medications, processes, and costs to yield insights about value-based care protocols
- Medication Revenue Integrity and 340B Consulting Services, which leverage the decades of collective clinical, technical and administrative experience of The Craneware Group™ experts.
It also comes with our 340B performance and compliance applications:
- Sentinel, for managing mixed-use settings
- Sentrex, for contract pharmacies
- Central Pharmacy Distribution, which helps large health systems manage the complexity and costs of medication supply chains while remaining compliant with 340B
The best results come when you use the entire suite, with multiple apps in one location. For example, using Trisus Medication Formulary ensures an accurate pharmacy chargemaster, which ensures the correct information is sent to our Sentinel or Sentrex applications to capture 340B eligibility. Meanwhile, Trisus Medication Claim manages billing compliance requirements like modifiers, volume and coding, while flagging inaccuracies.