Reimbursement

Over the past 30 years, health plans have changed from primarily conventional health care coverage to alternatives such as health maintenance organizations and, most recently, high deductible health plans.

In the current chaotic environment of reimbursement that depends on quality and cost savings, pharmacists should increase their presence.

Study suggests that the ACA improved financial risk protection against medical bills for low-income adults.

These changes would lower the beneficiary cost sharing on more expensive prescription drugs, promote the use of generic medications, and allow beneficiaries to know in advance and compare their out-of-pocket payments for different prescription drugs.

Girish Dighe, PharmD, MS, discusses pharmacy's role in a health system's financial performance.

A new report from the Florida Pharmacy Association and American Pharmacy Cooperative, Inc, alleges that pharmacy benefit managers (PBMs) in the state are favoring their own affiliated pharmacies in the Florida Medicaid Program, both by driving customers to those pharmacies and by reimbursing them at higher rates.

Several viable models continue to emerge for addressing the unique challenges of payment and financing for innovative, durable, curative gene and cell therapies.

Girish Dighe, PharmD, MS, discusses important partnerships within a health system looking to achieve revenue integrity.

Electronic health records and the data created are being used on multiple levels and continue to be a driving force for improving care and lowering health care costs.

Mark Vogler, RPh, is the owner of Martin-Tipton Pharmacy in Amarillo, TX. It is a high-volume pharmacy, doing about twice as many prescriptions per day as the national average.

Proposal seeks to provide different benefits and more stringent requirements than traditional Medicaid.

The easiest way to avoid misdiagnosis, inappropriate treatment, and potential loss of reimbursement is to prevent unsuitable testing.

The shift from fee-for-service to a value-based care payment model represents the growing understanding of the value of health care providers in improving overall patient outcomes.

Girish Dighe, PharmD, MS, explains the importance of change management within a closed-loop system.

Safety net providers, which historically work in underserved communities, have successfully petitioned state legislatures to take action on 340B 2-tier pricing.

Counties in Medicaid expansion states saw an 11% lower rate of heroin deaths and a 10% lower rate of deaths involving synthetic opioids compared with counties in non-expansion states.

The emergence of a new Medicare Advantage plan, Troy Medicare, offers much needed momentum to drive pharmacists’ services.

The rise in value-based reimbursement models has required oncology care providers to assume an unprecedented level of accountability.

The proposal, which is still largely conceptual, was a part of Newsom’s proposed 2020-2021 budget.1

The Supreme Court released their decision to review Rutledge v. Pharmaceutical Care Management Association, which could affect pharmacy benefits across the country.

A key demand was for the Ohio Department of Medicaid (ODM) to set a minimum reimbursement level and dispensing fees for Managed Medicaid, in order to ensure that pharmacies receive adequate reimbursement plans.

There are some basic tips or tricks to getting the most out of your insurance plan and to maintain the care patients are accustomed to.

Girish Dighe, PharmD, MS, explains why it's important to understand more than just the revenue integrity piece of the puzzle.

Jesse C. Dresser, Esq explains how DIR fees affect specialty pharmacists at the NASP Annual Meeting in Washington, DC.

Jesse C. Dresser, Esq explains a recent piece of PBM legislation from North Dakota and its implications for specialty pharmacy at the NASP Annual Meeting in Washington, DC.