Reimbursement

With patient pay responsibility expected to climb 50% of every health care dollar by 2020, solutions to streamlining reimbursement may help.

As part of his guilty plea, Calhoun admitted that he defrauded Medicare Part D of $1.6 million through an elaborate scheme in which he created a fictitious pharmacy on paper called “Cal’s Pharmacy” and used it to process hundreds of prescription claims for drugs that were never dispensed.

Blue Cross and Blue Shield of Texas is partnering with 11 Universities to study challenges that increase costs.

The Creating and Restoring Equal Access to Equivalent Samples Act of 2017 aims to expedite the entry of lower-cost biosimilars and generics into the market.

Pharmacy DIR fees increasingly are being misused by payers to retroactively claw back reimbursement to pharmacies for the prescription drugs that they provide to Medicare beneficiaries.

Potential actions related to the opioid epidemic and pharmacist provider status are on the horizon.

Senate Finance Committee Chairman Senator Charles Grassley pledged to “get to the bottom of the insulin price problem.”

This interoperable standard created to exchange information across the health care spectrum is gaining traction across the country.

Approximately 94% of widely-used brand-name drugs on the market between 2005 and 2017 more than doubled in price during that time.

Officials with CVS Health have announced that Walmart has opted to leave the CVS Caremark pharmacy benefit management (PBM) commercial and Managed Medicaid retail pharmacy networks due to a disagreement over reimbursement increases.

CVS Caremark has requested that Walmart continue to fill prescriptions as an in-network participating pharmacy through April 30, 2019.

Thom Cohn, Chief Strategy Officer, Asembia, discusses special considerations for the launch of a personalized drug.

Specialty pharmacies offer a wide range of services vital to manufacturers and patients alike.

At the 2018 ASHP Midyear Clinical Meeting and Exhibition, Ashley Mains Espinosa, PharmD, Director of System Pharmacy Business Services at SCL Health, offered advice on how pharmacy providers can work to overcome biosimilar reimbursement challenges and encourage biosimilar adoption.

Luis Torres, MBA, Vice President, Managed Care, BioPlus Specialty Pharmacy, discusses how collaboration between health care stakeholders is necessary to further the push towards a system that revolves around the patient.

A pharmacy owner facing an indictment charging her with submitting millions of dollars in fraudulent claims to Medicare and Medicaid is expected to be arraigned today in federal court in Brooklyn, New York.

In this video, Gordon Vanscoy, PharmD, MBA, CEO of PANTHERx, describes the methods of patient support used by PantheRx throughout treatment to provide optimal care.

A federal appropriations bill will not include bipartisan provision that would have required drug manufacturers to be more transparent with costs to consumers after it was blocked by House Republicans.

The American Hospital Association and individual hospitals have initiated new principles for ensuring good stewardship of the 340B drug program.

According to evidence presented at trial, from approximately December 2011 to August 2015, Ramirez, Shepherd and Nwoko conspired and schemed to defraud Medicare out of payments for medical services.

One in 5 test results showed potentially dangerous concurrent use of opioids and benzodiazepines in 2017.

With Hurricane Florence about to strike, pharmacies must take extra steps to maintain services for patients in need of lifesaving medications.

Spending for the 10 most expensive brand name combination drugs could have been reduced by an estimated $2.7 billion between 2011 and 2016 if lower-cost generics had been prescribed, according to researchers.

Jesse C. Dresser, JD, Partner, Frier & Levitt, LLC, speaks about pharmacy benefit manager-owned specialty pharmacies and how they can impact independent specialty pharmacies.

An evolving pharmacy practice started with the the owners' vision, and worked backwards to become a reality.