Clinical Role - Payer

Pharmacy Times® is a leader in providing the latest clinical updates, patient counseling tools and innovative solutions to payers, pharmacy benefit managers, formulary chairs and directors, managed care directors, quality assurance directors, and Medicaid/Medicare directors.

Long-term care (LTC) pharmacies caring for this population face a myriad of unique obstacles, especially the regulatory framework surrounding them.
 
How a pharmacy performs with respect to specific measures can be associated with a DIR fee.
Birth Control
New ruling means up to 126,400 women of childbearing age may need to pay out-of-pocket for birth control. 
 
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Expanded Medicaid program in Michigan found to largely benefit the most vulnerable patients. 

 
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Initiated in Arkansas, Rutledge v. PCMA is set to decide whether states have the authority to regulate pharmacy benefit managers.
 
Regardless of the channel through which a specialty medication is billed and filled, management strategies will be an essential cornerstone to controlling costs.
Multiple pharmacies recently received letters from ESI stating that on behalf of TRICARE and the Defense Health Agency, ESI was recouping money for compound drug claims submitted in 2015.
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A new study found disturbing evidence that black cancer survivors are more likely to face financial hardship on high deductible health plans than their white counterparts.
The pharmaceutical industry is already seeing the immense benefit of AI and machine-learning technology.
According to the investigators, payers and employers are increasingly adopting HDHPs in an effort to control rising health care costs.
A recent qualitative study presented a potential explanation for why health system specialty pharmacies often find it difficult to partner with payers.
Although some of the largest insurers have waived their cost sharing requirements, employer-sponsored “self-insured” health insurance plans are not required to adhere to these waivers.