Reimbursement

Research presented at the 2021 American Society of Health-System Pharmacists (ASHP) Specialty Pharmacy Conference suggests overall medical expenses for oncology patients were significantly improved by using an integrated health-system specialty pharmacy (HSSP) care model.

The American Society of Health-System Pharmacists’ (ASHP) first annual survey of health-system specialty pharmacies (HSSPs) offered insights into the concerns of specialty pharmacists and provided an opportunity for professionals in the field to outline a potential future for specialty pharmacy.

Pharmacies that received more than $750,000 in federal funds, including funds from the CARES Act Provider Relief Fund, will be subject to single audit requirements.

There seems to be a growing divergence of messages in the marketplace on how the pharmacy benefit is valued.

A research team from the university wanted to further investigate whether patients with or without insurance were paying more because of rebates to insurers.

Each drug formulary has the evidence to support why a medication is included or excluded from a health plan and explaining that to the patient is difficult.

These financial challenges can include difficulty paying medical bills or the inability to pay them at all, high financial distress, cost-related medication non-adherence, food insecurity, and delayed or foregone care due to cost.

Specialty medications should not be defined by their cost and should instead be defined by their efficacy.

Susan Lang, MA, MBA, the CEO of XIL Health and former senior executive with Express Grips, discusses what might happen to independent pharmacies if things continue as they are following the financial difficulties of the pandemic.

Susan Lang, MA, MBA, the CEO of XIL Health, discusses how pharmacies that have already been hard hit by the pandemic may be impacted if Pfizer goes through with their projected increased in COVID-19 vaccine prices.

Michael Holden, FRPharmS, FRSPH, associate director of Pharmacy Complete in the United Kingdom, discusses some of the key differences between the role of the pharmacist in the United Kingdom versus the United States.

Catherine Duggan, FRPharmS, CEO of International Pharmaceutical Federation, discusses the role and the authorities of the pharmacist internationally, and the effect the pandemic has had on that role globally.

Susan Lang, CEO of XIL Health and former senior executive at Express Scripts, discusses some of the reimbursement issues that have been arising for pharmacies while administering COVID-19 vaccines.

Susan Lang, CEO of XIL Health and former senior executive at Express Scripts, discusses the impact of declining reimbursements on pharmacies that were already hard hit by the COVID-19 pandemic.

High engagement and collaboration between health systems and health plans is essential to implementing value-based models, according to a session at the Pharmacy Quality Alliance 2021 Annual Conference.

Policy changes impacting the star ratings for 2022 include additional flexibility provided during the COVID-19 pandemic and a revised Extreme and Uncontrollable Circumstances policy.

Further integration with care teams and using data to demonstrate the value of pharmacists will be essential to maintaining the momentum created by the COVID-19 pandemic.

The APhA has joined a federal lawsuit filed by the NCPA in January to challenge DIR fees.

The necessary push for the health care industry to move to whole-person care instead of condition-oriented models and tactics for applying a value-based model in pharmacy benefits.

The Star Rating for Biosimilars Act, HR 2855, aims to create a biosimilars access measure in the Centers for Medicare and Medicaid Services’ Star Ratings Program.

There are a number of ways in which job design and working conditions can be improved in the community pharmacy setting, either on the store level or on an organization-wide basis.

Patient and provider organizations urge the Department of Health and Human Services and the Biden administration to enact policies and protections that improve prescription drug affordability for people in the United States.

The report further showed that drug expenditure in nonfederal hospitals declined 4.6%, while drug spending in home care settings increased 13%, and drug expenditures in nonfederal hospitals spiked in the 3 weeks immediately following the March 8, 2020 lockdown.

The study further explored the various aspects of financial hardships, including material, psychological, and behavioral measures.

Health systems individually have struggled to demonstrate improvements to total cost of care because, without data about patients they do not serve, they cannot define a comparison group.