Our time is now! For decades, pharmacists have been excluded from health plan provider networks limiting the care we can provide to our patients. The passage of landmark legislation SB 5557 has opened the door that had previously been locked. Health plans are now required by law to treat us like other healthcare providers. This means most commercial health plans must include some pharmacists in their provider networks and pay medical claims for covered patient care services. As you can imagine, this has created a great deal of excitement and questions across the country. Since we are being held to the same standards as all other providers, there is much to learn.This is very different than pharmacy contracting and billing pharmacy claims through PBM's.
We are here to help! The WSPA is working hard on your behalf to help answer your questions and provide resources to assist pharmacists in their pursuit to be included in health plan provider networks.